促進學齡期兒童與罹患癌症母親 之親子互動研究

A Study of Facilitating School-Aged Children’s Interaction with His/Her Mothers who Have Cancer

張純純(Chun-Chun Chung)

指導教授 ： 陳月枝

國立臺灣大學/醫學院/護理學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01231

摘要

本研究方法是以質性研究法，瞭解促進學齡期兒童與罹患癌症母親之親子互動研究，採立意取樣，研究對象為北部某醫學中心中符合研究收案條件之研究對象，共計收案學齡期兒童五位，其中男生1人，女生4人，平均年齡7.8歲，每位受訪者實際訪談的次數為二次，資料收集的方式，採畫圖、半結構式訪談指引，與研究對象進行會談，共得221個行為單元；罹患癌症母親五位，平均年齡42.6歲，每位受訪者實際訪談的次數為三次，資料收集的方式，半結構式訪談指引，與研究對象進行會談，共得223個行為單元。每一位均經過二次以上的接觸及熟悉之後才進行研究，在整個接觸的過程中，研究者扮演傾聽、分享及觀察的角色，盡量不涉及研究者本身的價值觀及批判。訪談結束後，將訪談資料撰寫敘述性文字，再以內容分析方法歸納研究對象的關注內容及因應行為，並予歸類及命名。總結結果如下：
學齡期兒童關注內容可歸納成三方面，在家庭關係佔最多55.2%，其次是母親疾病佔35.3%，學校生活佔最少9.5%。在家庭關係方面，關注內容又以家庭成員互動佔最多57.4%，其中互動關係改變佔80.0%。罹患癌症母親關注內容可歸納成三方面，在家庭關係佔最多55.6%，其次是自身疾病佔37.7%，婚姻生活佔最少6.7%。在家庭關係方面，關注內容又以家庭成員互動佔最多45.2%，其中互動方式改變佔76.8%。
學齡期兒童所採取的因應行為可歸納成三方面，認知運作佔最多47.1%，其次是調整行為佔44.3%，評價行為最少佔8.6% %。罹患癌症母親所採取的因應行為可歸納成三方面，在認知運作佔最多46.2%，其次是調整行為佔45.7%，評價行為最少佔8.1%。
護理的介入措施評值得知，親子互動非語言部份以互動頻率、互動時間，作資料分類、分析，互動頻率結果顯示，五對親子見面頻率增加3.64次/週，通電話頻率平均減少2.90次/週。互動時間結果顯示，五對親子見面時間增加1.6小時/次，通電話頻率平均減少2.3分鐘/次。綜合以上結果顯示，五對親子總聯時間由1.23小時/週增加到11.17小時/週，平均增加9.94小時/週。
親子互動語言部份，母親表示，藉由卡片或圖畫引導的方式，讓她們感到很窩心、感動，並會替母親著想，關心母親疾病治療情形，積極正向面對母親疾病，並分擔父母親角色，照顧家庭中其他成員。兒童表示，藉由研究者，讓他們增加與母親相處的機會，並重新認識母親疾病及治療方式，減少對疾病的不瞭解及害怕未來所造成的結果。綜合護理的介入措施評值，研究者所扮演的角色是在親子間做為橋樑，由提供卡片或圖畫的方式，讓親子間彼此表達對親子互動之期待及情感，讓親子間增進彼此互動。
本研究結果，能促進罹患癌症母親與學齡期兒童親子間互動關係，以及其他護理人員對兒童認知能力及行為表現了解與認識，以達到真正以「家庭為中心」的護理目的。

關鍵字

關注 ； 親子互動 ； 母親 ； 癌症 ； 學齡期兒童 ； 因應行為

並列摘要

The study adopts qualitative approach and is meant to understand and facilitate the interaction between school-aged children and their mothers with cancer. The study is conducted in a medical center in Taipei and has 5 qualified samples, including 1 boy and 4 girls, aged 7.8 years old on the average. Each sample was interviewed twice, with graphic, semi-structured guidance. The 5 cancer patients were interviewed 3 times, with semi-structured guidance. In the end, 233 behavior units are recognized. The researchers contacted each interviewed person at least twice to create familiarity before starting the survey, and during the process, the researchers take a listening, sharing, and observing role, trying to keep personal judgment least involved. Each interview is transcribed into narrative form and then the content is analyzed to classify and name the objects’ concern and coping behavior. The conclusions are as follows:
The school-aged children’s concerns are in 3 aspects: family relationship the highest 55.2%, then mother’s illness 35.3%, and school life the lowest 9.5%. In the aspect of family relationship, 57.4% is about the interaction among family members, in which 80% is about the change of family interaction. The mother cancer patients’ concerns are in 3 aspects: family relationship the highest 55.6%, then their own illness 37.7%, then marriage life the lowest 6.7%. In the aspect of family relationship, 45.2% is about the interaction among family members, in which 76.8% is about the change of family interaction.
The coping behavior of the children can be divided into 3 domains: cognitive operation 47.1%, adaptive behavior 44.3%, and evaluating behavior the lowest 8.6%. The coping behavior of the mothers can be divided into 3 domains: cognitive operation 46.2%, adaptive behavior 45.7%, and evaluating behavior the lowest 8.1%.
The intervention of nursing care is evaluated through analyzing the nonverbal interaction between children and their mothers in terms of frequency and time. The result shows the five cases increased meeting frequency by 3.64 times per week, and telecommunications decreased 2.90 times per week. And they increased 1.6 hours of meeting time and decreased 2.3 minutes in each telecommunication. In total, the contact time of these five pairs increased from 1.23 hours per week to 11.17 hours per week.
As to the verbal communication, through cards and drawings, the mothers can feel their children are sweet, considerate, caring about their mothers’ illness and treatment, positively facing mother’s illness, sharing father’s duties, and taking care of other family members. The children feel the researchers help enhance opportunities to get along with their mothers, gain new understanding of their mothers’ illness and treatment, and lower their misunderstanding and fear of the illness and its subsequences. The effects of the nursing care show that researchers help bridge mothers and children’s interaction. By providing cards and drawings, the researchers help them understand each other’s expectation of their interaction and emotions, and increase the interaction.
The findings of the study can facilitate the interaction between mothers with cancer and their school-aged children, and help nursing people understand the cognitive abilities and behavior of the patients’ children, so as to achieve the goal of “family-centered” nursing approach.

並列關鍵字

school-aged children ； cancer ； mother ； interaction

參考文獻

金繼春 (1986)•學齡期白血病患童母親所感受到的壓力源及因應策略•國立台灣大學醫學院護理學研究所碩士論文。

中文部份

王文科 (1983)．認知發展理論與教育–皮亞傑理論的應用．台北：五南。

王如華(1982)．中國家庭內癌症患孩對手足影響之研究．護理雜誌，29(4)，81-86。

危止芬 (1999)．投射技術心理測驗．台北：雙葉。