文化價值與截肢的決定

Cultural Values and the Decision to Amputate

陳都美(Du-Mei Chen)

《弘光醫專學報》 21期 (1993/01) Pp. 3-22

https://doi.org/10.6615/BHIMNT.199301.21.01

摘要

截肢衝擊在生理上及心理乃至社會情境，都會造成很大的創傷(Mary Powell 1982 ,P.570)。研究者在臨床上，常看到截肢患者要面對生命危險，嚴重的殘障肢體功能喪失與身體心像改變。那種失落、悲傷、恐懼及無奈的心靈交戰，而難以面對截肢的決定。本研究主要目的是要以文化價值的背景，來探討什麼因素會影響病患對截肢的決定？截肢患者對截肢的想法？與性別、年齡、適應症、病程又有何相關係？護理人員所要關懷的，不僅僅是生理上的病痛，更重要的是要真正瞭解病人的感受，要以同理心、知識性與科學性去探討病人對截肢的看法、想法。然而文化具有潛移默化的力量，影響人的價值觀，價值觀又影響人的決定意念，人會選擇對自己有價值、有利者付諸實行(Geetz. C. 1973, Le Yin 1973)本研究採用基底理論研究法(Chenitz & Swansen 1986)，先進立良好治療性人際關係後，再獲得患者同意採錄音訪談收集資料。凡民國七十八年七月一日起至七十九年一月三十一日止，在中部某醫學中心骨科病房，收滿二十位個案，經專家效度，做質性的研究並以中國人的文化價值觀點，分析截肢患者心底深處的感受意念。促使醫療成員尊重患者的自主權，期能更實際更貼切的提高醫療服務品質。研究發現：影響截肢決定的因素可歸納為七類：即害怕殘職、醫療勸導、生命價值觀、怕痛、家庭支持系統、朋友的支持力及大男人氣慨。這七種因素在本研究中，患者對截肢的決定接受與否，真有很大的影響；在患者對截肢的看法方面：抱持樂觀的審法時表示困難可以克服，但悲觀看法則表示害怕殘廢，無法謀生，成為家庭的累贅，不顧苟延殘生曾有放棄求生的念頭。在本研究受訪者都曾表示怕別人有意無意指指點點異樣的眼光。在與性別、年齡、適應症、病程的輔係：在性別上男性佔55 %，女性佔45 %。年齡以六十歲以上者居多，佔45 %。適應症，以糖尿病合併血管病變者最多佔是5%。痛程，個別性差異相當大，有的即刻決定，有的接達十三年後才決定截肢。由這次研究深切瞭解做決定是一種動力系統性的過程。傳統文化下個人價值觀對健康維護與求治溝通因人而異，會還擇與個人價值有利者去做。故期盼醫療成組人員能以文化價值觀點尊重病人，促使達到本土化、知識性、科學化的人性醫療照護。

關鍵字

文化價值 ； 截肢

並列摘要

Culture influence an individual values standpoint. The different culture values influence one's idea of decision making. Loss of a limb is a serious mutilation not only the physical status but also the patient faces with the many effects of amputation; such as psychological impact, social impact et, so that hardly decide to have the amputation. The purpose of this study that would Iike to understand what the patients have for accepting or refusing to have an amputation, what is the inpact of amputation and inquire into the approach of the subject from a cultural values standpoint. What does it mean to the patient to have the amputation? That persons with different disease, ages , sex and prognosis had different reactions , what relation between them? This study was conducted using Ground Theory Qualitative Research base on Chinese Culture Values aspect to anlaysis feeling and idear in their dept mind. The data collection for 20 cases were collected for 7 months period from July 1, 1989 59 January 31, 1990, by admitted chance and participant observation in the orthopeadic ward of Medical Center in Taichung Taiwan R.O.C. Data were collected by interview with radio record and written down for analysis throught patient's agreetment. In this study found the major influence factors for amputation such as(1) fear maimed(2)medical advice(3)Life value(4)fear paint(5) Family Support(6)Friend(7) manhood , then the patient's attitude about amputation are some optimistic view but some pessimistic view. Also have individual difference from sex, age, indication and prognosis. Decision making is a dynamic and systematic process by which goal-directed choices of perceived aIternatives are made and acted upon by individuals to attain a goal which is influenced by culture value. So researcher expect medical team member can respect the patient's anotomy base on Chinese Culture Values to improve more humanize medical service.

並列關鍵字

Cultural Values ； Amputation