末期病人失志對靈性安適之影響

The Impact of Demoralization on Spiritual Well-Being in Terminally Ill Patients

劉美玲(Mei-Ling LIU) ； 蕭雅竹(Ya-Chu HSIAO)

《護理雜誌》 66卷1期 (2019/02) Pp. 48-59

https://doi.org/10.6224/JN.201902_66(1).07

摘要

背景：末期病人常有失志症狀進而影響靈性安適，有關失志與靈性安適相關研究尚屬起步階段，不論是失志與靈性兩者的相關性或是失志照顧模式的建立，都需要更多研究加以驗證與支持。目的：探討末期病人失志狀態、靈性安適現況與其影響因素，以及了解末期病人背景資料、疾病特性、失志對靈性安適的預測性。方法：本研究以橫斷式相關性研究設計，以南部某教學醫院接受安寧療護之末期病人為對象，以結構式問卷收集研究資料。研究工具包括失志量表、靈性安適量表與基本人口學資料。以皮爾森績差相關及階層多元迴歸分析兩者的相關性與失志對靈性安適的預測。結果：共82位研究對象參與本研究，81.7%屬高失志狀態，靈性安適平均得分為31.7分，屬中等程度之靈性安適狀態。失志得分與靈性安適得分呈顯著負相關（r = -.600, p ＜ .01），回歸分析結果發現控制人口學特性、疾病特性等變項，失志得分能有效預測靈性安適得分（解釋力達12.7%，β = -.41，p ＜ .001），顯示失志程度越高，靈性安適程度則越低。結論／實務應用：失志是末期病人常見之問題，且為影響末期病人靈性安適之重要因素之一。因此，臨床上應及早評估與辨識病人失志狀態，建立失志相關的照護模式，以協助末期病人靈性安適。

關鍵字

末期病人 ； 失志 ； 靈性安適

並列摘要

Background: Terminally ill patients often experience demoralization, which negatively impacts their spiritual wellbeing. However, studies on the relationship between demoralization and levels of spiritual well-being in Taiwan are still at an early stage. Thus, more research is required to verify and support the correlation between demoralization and spirituality and to establish methods to care for and treat demoralization. Purpose: The purposes of this study were to investigate the demoralization and spiritual-well-being status of terminally ill patients and to determine the value of demographic data, disease characteristics, demoralization in predicting spiritual well-being. Methods: A cross-sectional research design was used to evaluate terminally ill patients who were currently receiving hospice care at a teaching hospital in southern Taiwan. Data were collected using a structured questionnaire that included a demographic datasheet and the Chinese demoralization and spiritual well-being scale. Pearson product-moment correlation and hierarchical multiple regression were performed to analyze the relationship between the target variables and spiritual well-being. Results: Of the 82 participants surveyed, 81.7% had high levels of demoralization. The average spiritual well-being score for the participants was 31.7 (moderate). A significant and negative correlation was found between degree of demoralization and level of spiritual well-being (r = -.600, p ＜ .01). Regression analysis showed that, after controlling for demographic characteristics, disease characteristics, and other variables, demoralization scores were shown to predict the spiritual-well-being score, explaining 12.7% of total variance (β = -.41, p ＜ .001). In other words, higher demoralization was associated with lower spiritual well-being. Conclusions: Demoralization is a common problem in people with terminal illnesses and is an important factor affecting spiritual well-being in this patient population. In clinical practice, early assessment and identification of demoralization in patients as well as establishing relevant models of care for demoralization are necessary to help patients attain spiritual well-being at the end of life.

並列關鍵字

terminal-illness patient ； demoralization ； spiritual well-being

參考文獻

李隆軍、胡中傑、黃曉峰、林鉅勝、張瑛瑛（2011）．癌症末期病人安寧居家的主要照顧議題分析．安寧療護雜誌，16（2），151–167。[Lee, L. C., Hu, C. C., Hwang, S. F., Lin, C. S., & Chang, Y. Y. (2011). The main care issues among terminal cancer patients in hospice home care service. Taiwan Journal of Hospice Palliative Care, 16(2), 151–167.] https://doi.org/10.6537/TJHPC.2011.16(2).2

陳怡如、余文瑞、何清幼（2012）．某社區醫院安寧團隊照護模式初探．台灣家庭醫學雜誌，22（3），130–140。[Chen, Y. J., Yu, W. R., & Ho, C. Y. (2012). An exploration of hospice-palliative care in a community hospital. Taiwan Journal of Family Medicine, 22(3), 130–140.] https://doi.org/10.7023/TJFM.201209.0130

方俊凱（2013）．癌症病人的失志症候群．台灣醫學，17（2），149–154。[Fang, C. K. (2013). Demoralization in cancer patients. Formosan Journal of Medicine, 17(2), 149–154.] https://doi.org/10.6320/FJM.2013.17(2).07

洪曉琪、陳虹汶、張義芳、楊育正、劉建良、謝瑞坤…方俊凱（2010）．癌症病人失志量表中文版之信效度檢測．內科學誌，21（6），427–435。[Hung, H. C., Chen, H. W., Chang, Y. F., Yang, Y. C., Liu, C. L., Hsieh, R. K., ... Fang, C. K. (2010). Evaluation of the reliability and validity of the mandarin version of demoralization scale for cancer patients. Journal of Internal Medicine of Taiwan, 21(6), 427–435.] https://doi.org/10.6314/JIMT.2010.21(6).06

李玉琪、周汎澔、王秀紅（2015）．失志的概念分析．護理雜誌，62（3），83–88。[Li, Y. C., Chou, F. H., & Wang, H. H. (2015). Demoralization: A concept analysis. The Journal of Nursing, 62(3), 83–88.] https://doi.org/10.6224/JN.62.3.83