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  • 學位論文

生活討論會介入對護理之家老人憂鬱狀態、孤寂感、知覺自主性之成效

The Effect of Discussion Group on Elderly Depression, Loneliness, Autonomy in a Nursing Home

指導教授 : 吳麗珍

摘要


本研究主要目的是探討「生活討論會」之介入措施,對護理之家老年人憂鬱狀態、孤寂感、知覺自主性之成效。採縱貫式類實驗性研究設計,於南部某家醫院附設護理之家,以方便取樣的方式,共招募55位護理之家住民參與研究。研究者以不同居住樓層分配實驗組與控制組,27位老人接受生活討論會介入措施,28位控制組老人接受護理之家一般日常生活照護模式。兩組在年齡、性別、教育程度、宗教信仰、自覺健康狀況均無統計顯著差異,罹患慢性病之數目,控制組(M = 2.29, SD = 0.71)顯著高於實驗組(M = 1.59, SD = 0.64)。本研究測量工具包括老人憂鬱量表簡明版、UCLA孤寂感量表、PEA老人知覺自主性量表。第一次前測,實驗組之憂鬱狀態得分(M = 8.26, SD = 2.943)顯著高於控制組(M = 6.25, SD = 2.591),孤寂感和知覺自主性兩組間沒有顯著差異。四週後第二次前測,實驗組之憂鬱狀態得分(M = 8.74, SD = 2.474)仍然顯著高於控制組(M = 6.71, SD = 3.914),孤寂感和知覺自主性兩組間沒有顯著差異。 介入措施包括每週一次,連續三週,每次50分鐘的生活討論會。介入措施之後,後測實驗組憂鬱狀態總分4.56分,控制組為6.71分,兩組間之後測得分有顯著差異(t = 3.085, p = .003)。從兩次前測和後測來看兩組之組內差異,實驗組憂鬱狀態總分從第一次前測8.26分,間隔四週後第二次前測上升至8.74分,介入措施後降為4.56分共降低4.18分;控制組從第一次前測6.25分,第二次前測上升至6.71分,後測上升至7.50分,憂鬱程度增加1.25分,介入措施後實驗組憂鬱狀態比起控制組顯著改善(t = -7.611, p = .000)。 孤寂感之後測得分,實驗組45.19分,控制組54.96分,兩組間之後測得分有顯著差異(t = 2.989, p = .004)。從兩次前測和後測來看,孤寂感總分實驗組從第一次前測47.37分,第二次前測上升至55.74分,介入措施後測降為45.19分。控制組孤寂感總分第一次前測44.11分,第二次前測上升至52.61分,後測為54.96分。介入措施後實驗組孤寂感比起控制組顯著改善(t = -4.581, p = .000)。 知覺自主性之後測得分,實驗組58.93分,控制組46.57分,兩組間之後測得分有顯著差異(t = -4.427, p <.001)。從兩次前測和後測來看,知覺自主性總分實驗組從第一次前測50.59分,第二次前測降至45.59分,介入措施後測升為58.93分。控制組總分第一次前測51.57分,第二次前測降至47.61分,後測為46.57分。介入措施後實驗組知覺自主性比起控制組有顯著改善(t = 7.706, p = .000)。 本研究結果發現生活討論會介入,對護理之家老年人憂鬱狀態、孤寂感及知覺自主性的改善比控制組多,且皆達統計顯著差異。特別是實驗組老人之憂鬱狀態在兩次前測均高於控制組,但在介入措施之後,憂鬱狀態顯著低於控制組。當老人有機會在生活討論會中談論他們的生活狀況和需要時,將有助於改善他們在機構中的情緒、降低他們的孤寂感、增進自主性。

並列摘要


A longitudinal, quasi-experimental design was used in this study to examine the effect of “discussion groups” on depression, loneliness, and perceived autonomy in nursing home residents. A convenience sample of 55 nursing home residents, 27 in the experimental group and 28 in the control group, was recruited from Southern Taiwan. The experimental group and control group resided on different floors. In addition to the routine care, the experimental group participated in discussions groups of under 10 people for 50 minutes a week for three weeks. The discussions were focused on their daily life experiences and any problems they had encountered in the nursing home. The control group received routine care only in the nursing home. No statistically significant differences were found between the two groups with regard to age, gender, number of children, education, religion, and self-reported health. The control group, however, reported a significantly higher number of chronic illness than the experimental group (M = 2.29, SD = 0.71 vs M = 1.59, SD = 0.64, t = 3.80, p < .001). Two pretests were administered 4 weeks apart and one posttest was conducted using three instruments: the Geriatric Depression Scale Short Form (GDS-SF), the UCLA Loneliness Scale (Version 3), and the Perceived Enactment of Autonomy scale (PEA). The first pretest showed that the GDS-SF score of the experimental group (M = 8.26, SD = 2.943) was significantly higher than that of the control group (M = 6.25, SD = 2.591)) (t = -2.690, p =.01), loneliness and perceived autonomy were not statistically distinguishable between two groups. In the second pretest, the GDS-SF score of the experimental group (M = 8.74, SD = 2.474) remained significantly higher than the score of the control group (M = 6.71, SD = 3.914) (t = -2.285, p = .026). Again, there was no statistical difference in loneliness and perceived autonomy between the two groups. After the intervention, the GDS-SF score in the experimental group (M = 4.56, SD = 3.130) was significantly lower than that of the control group (M = 7.50, SD = 3.892) (t = 3.085, p = .003). Between the second pretest and the posttest, the GDS-SF score for the experimental group decreased by 4.18, while the score for the control group increased by 0.79. This difference in the change is statistically significant (t = -7.611, p <0.01). The UCLA loneliness score in the posttest was significantly lower for the experimental group (M = 45.19, SD = 11.17) than for the control group (M = 54.96, SD = 12.989) (t = 2.989, p = .004). Between the second pretest and the posttest, the UCLA Loneliness score for the experimental group decreased by 10.55, while score for the control group increased by 2.35. The difference in the change between these two groups is statistically significant (t = -4.581, p <0.01). The Perceived Enactment of Autonomy score in the posttest was significantly higher in experimental group (M = 58.93, SD = 9.025) than in the control group (M = 46.57, SD = 11.474) (t = -4.427, p < .001). Between the second pretest and the posttest, the Perceived Enactment of Autonomy score for the experimental group increased by 13.33, while the score for the control group decreased by 1.04. The difference in the change between the two groups is statistically significant (t = 7.706, p <0.01). This study found that discussion groups significantly alleviated feelings of depression and loneliness and increased the perceived autonomy compared to the control group. When nursing home residents have the opportunity to talk about their experiences and problems in the nursing home, their depressive moods and feelings of loneliness were reduced and their perceived autonomy improved.

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