中風病人之職能治療參與經驗探討

An Investigation of Engagement Experiences of Patients with Stroke in Occupational Therapy

王怡晴(Yi-Ching Wang)

指導教授 ： 呂文賢

中山醫學大學/醫學科技學院/物理治療學系碩士班/碩士(2016年)

摘要

前言：中風病人的參與治療經驗會影響其參與行為與表現，更影響職能治療品質與療效。然以往研究多以治療師觀點衡量病人的治療參與。本研究目的在建立以中風病人之「治療參與經驗」為核心的紮根理論，探討病人參與治療活動之內涵與特質，及發生之情境脈絡。
方法：本研究採立意取樣，從4家醫療院所邀請14位中風病人，採用半結構式深度訪談與參與觀察方式收集資料，並與此醫療院所之職能治療師舉行焦點團體。每次訪談結束後將錄音檔翻譯為逐字稿並進行譯碼，使用「紮根理論」分析法進行分析以發展理論架構。
結果：本研究共得13個主要範疇，歸納為兩個主軸現象：「出席治療」與「投入治療」。在選擇性譯碼階段，選擇「生活常規重建」為核心範疇，作為本紮跟理論的中心現象，具有兩個重要的性質「現在可選擇性」與「未來可改變性」，勾勒出不同脈絡下中風病人之職能治療參與經驗與行動。
結論：本研究顯示，核心範疇的兩個主要性質「現在可選擇性」與「未來可改變性」。因此中風病人的生活常規重建，由知覺職能治療能夠帶給自身的益處，以及病人知覺對於外在資源與自身狀況的掌握程度所構成。建議在臨床實務上，為提高中風病人的職能治療參與，治療師必須考量病人這二種感受。本研究成果將有助於職能治療師對中風病人參與治療脈絡的了解，藉以提升病人的參與程度，進而提升治療品質與成效。

關鍵字

參與 ； 職能治療 ； 紮根理論 ； 中風

並列摘要

Introduction: The experience of therapeutic engagement of patients with stroke would influence the patients’ behaviors and performance of engagement, and then would influence the quality of therapy and therapeutic effects. In the past, most studies related to therapeutic engagement of patients with stroke focused on the perspectives of occupational therapists. The purpose of this study was to constructs a grounded theory based on the experience of therapeutic engagements of patients with stroke, to explore the contents and characteristics of the therapeutic engagement and the contexts where the therapeutic engagements occur.
Methods: A total of 14 patients with stroke from 4 hospitals were recruited to this study by purposive sampling. The In-depth semi-structure interview and participation observation were used to collect data. Focus-group interviews of occupational therapists from abovementioned 4 hospitals were employed. The interviews were audiotaped and transcribed to verbatim as texts for analyzing. All the data were analyzed with grounded theory to develop a theory.
Results: A total of 13 main categories were identified, and they were grouped into two main phenomena: the “participation in therapy” and the “engagement in occupational therapy”. In selective-coding stage, the “reconstruction of daily routines” was chosen as the core category and the main phenomena of the grounded theory. Two properties were included in the core category, including “selectivity at present” and “changeability in the future”. These two properties depicted the experiences and actions of therapeutic engagement of patients with stroke under various contexts.
Conclusion: The results of this study showed that the core category had two properties “selectivity at present” and “changeability in the future”. Thus, the “reconstruct of daily routine” was constituted by the patients’ perceptions of own benefit from occupational therapy, and the perceptions of mastery for external resources and their own conditions. We suggest that in clinical practice, the therapist should consider these two perceptions of patients with stroke to increase their engagement in occupational therapy. The results of this study would help occupational therapy understand the contexts of therapeutic engagement, and thereby to promote the extent of the therapeutic engagement of patients, and to enhance the quality and effectiveness of treatment.

並列關鍵字

Engagement ； Occupational Therapy ； Grounded Theory ； Stroke

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