結腸造口患者靈性安適與心理社會調適

Spiritual Well-being and Psychosocial Adjustment among Patients with Colostomy

李佳純(Chia-Chun Li)

指導教授 ： 黃秀梨

國立臺灣大學/醫學院/護理學研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.02144

摘要

本研究為橫斷性描述性相關研究，探討結腸造口患者術後靈性安適與心理社會調適，採立意取樣方式，在台北市某醫學中心之胃腸外科門診，以結構式問卷，包括「個案基本特質調查表」、「靈性安適量表」、「心理社會調適量表」，收集41位結腸造口患者為研究群體，所蒐集的資料以社會統計學套裝軟體（Statistical package for the social science, SPSS for Windows 12.0）進行資料的分析。研究結果歸納如下：
一、結腸造口患者靈性安適屬「中等程度」，其中宗教安適與存在安適也屬「中等程度」。宗教安適因素中，結腸造口患者相信神會看顧自己，不會受個人情感影響，對日常情況不會感興趣。存在安適因素中，結腸造口患者對於自我人生感到充實和滿意，但對自己的未來仍會感到不安。
二、結腸造口患者心理社會調適，43.8%的研究對象心理社會調適功能失常。心理社會調適以「非共居家人調適」最佳，其次為「健康照顧調適」，最差調適為「性生活調適」。
三、結腸造口患者靈性安適的影響因素方面，手術後7-12個月、手術後13-24個月、心理社會調適，三個因素對靈性安適具有顯著預測力，可解釋變異量為62%，亦即手術後7-12個月的結腸造口患者有最差的靈性安適，手術後13-24個月的結腸造口患者有最高的靈性安適，術後心理社會調適愈佳的結腸造口患者，靈性安適程度也會較高。
四、結腸造口患者心理社會調適的影響因素方面，靈性安適、生病後增加支出數目、生病後收入有改變，三個因素對於心理社會調適具有顯著預測力，可解釋變異量為65%，亦即靈性安適程度愈高，則結腸造口患者術後心理社會調適愈佳，生病後增加支出愈多，則心理社會調適愈差，生病後收入有改變者比收入無改變者的心理社會調適差。
五、結腸造口患者靈性安適與心理社會調適的相關性，靈性安適與整體心理社會調適、工作生活調適、家庭生活調適、社會環境調適呈負相關，即靈性安適程度愈高，則術後整體心理社會調適、工作生活調適、家庭生活調適、社會環境調適愈佳。
有鑑於臨床入院靈性評估只限於宗教信仰種類，本研究結果顯示靈性安適顯著影響術後心理社會調適，且結腸造口患者術後心理社會調適以性生活調適最差，國人較為保守，很少提出性問題，造成性問題未被重視。未來患者入院時靈性安適評估不容忽略，應提供適當靈性照護措施，並主動提供性生活諮詢，促使患者能有較佳的靈性安適與術後心理社會調適。

關鍵字

結腸造口患者 ； 靈性安適 ； 心理社會調適

並列摘要

This research is a descriptive cross-sectional study, which discusses spiritual well being and psychosocial adjustment among colostomy patients. Sampling was performed in a medical center’s Department of Surgical Gastroenterology outpatient unit in Taipei City. A structured questionnaire, including “personal characteristics of the patient”, “the spiritual well-being scale” and “the Psychosocial Adjustment to Illness Scale for colostomy patients”, was used. The study objects were 41 colostomy patients , and the collected data was analyzed using a statistical package for the social sciences, SPSS for Windows 12.0. The results may be categorized into the following:
1. The spiritual well being of colostomy patients is at the “intermediate level”, for both religious well being and existential well-being. In the aspect of religious well being, colostomy patients believe that God will take care of them, they are not affected by personal emotions, and they are not interested in daily conditions. In the aspect of existential well-being, colostomy patients feel fullness and satisfaction about their own lives, but are still concerned about their future.
2. Among the colostomy patients, 43.8% of them had functional impairment in their psychosocial adjustment. The psychosocial adjustment works the best with extended family relationships, then, with the health care orientation and the worst with sexual relationships.
3. Looking at the effect factors of spiritual well-being for colostomy patients , 7-12 months post surgery, 13-24 months post surgery and psychosocial adjustment are the three factors that have significant predictability. The variance (R2) is 62%, which includes the worst spiritual well-being for patients of colostomy 7-12 months post surgery, and the best spiritual well-being 13-24 months post surgery. Colostomy Patients with better psychosocial adjustment will have better spiritual well-being.
4. Looking at the factors of psychosocial adjustment for colostomy patients, spiritual well-being, increased expenditure after felling ill, and the income changes after felling ill are the three factors with significant predictability. The variance (R2) is 65%, which shows that those with better spiritual well-being will have a better psychosocial adjustment. The more the expenditure after falling ill, the worse the psychosocial adjustment. Patients with income changes had worse levels of psychosocial adjustment than patients without income changes.
5. The relationship between the spiritual well-being and psychosocial adjustment for colostomy patients shows that negative correlations can be found in spiritual well-being, the overall psychosocial adjustment, working life adjustment, family life adjustment, and social environment adjustment. In other words, after having the surgery, better spiritual well-being is accompanied by better psychosocial adjustment, working life adjustment, family life adjustment, and social environment adjustment.
In view of the fact that the spiritual evaluation of clinical hospitalization is limited to the type of religion, this research shows that spiritual well-being significantly affects post-surgical psychosocial adjustment, and the sexual relationship provides the worst psychosocial adjustment for colostomy patients. As people in Taiwan are more conservative, it is rare for people to talk about sexual problems, which have been neglected. In the future, when patients are being hospitalized, the spiritual well-being evaluation is essential to provide appropriate spiritual care strategies and take the initiative on sexual life consultancy services. As a result, the patients will have better spiritual well-being and post-surgical psychosocial adjustment.

並列關鍵字

Colostomy Patients ； Spiritual Well-Being ； Psychosocial Adjustment

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