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系統識別號 U0026-0302201300021500
論文名稱(中文) 想法領域侵犯對失智症病人躁動行為的影響
論文名稱(英文) The effect of territorial offenses on agitation in patients of dementia.
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 101
學期 1
出版年 102
研究生(中文) 簡鈺珊
研究生(英文) Yu-Shan Chien
學號 tc6991032
學位類別 碩士
語文別 中文
論文頁數 79頁
口試委員 指導教授-白明奇
召集委員-詹寶珠
口試委員-馬慧英
中文關鍵字 失智症  領域侵犯  心跳變異  身體壓力中心 
英文關鍵字 dementia  territorial  heart rate variability  center of pressure 
學科別分類
中文摘要 人與人之間互動如要維持彼此尊重、讓彼此感到舒適,很重要的關鍵,要能領域(Territory)是個虛擬,卻實質影響人與人之間互動、生存與感到自在的。領域從空間領域開始定義,也就是物理空間的地盤,物品領域則是指物品的所有權,同理可知,想法領域(perspective territory)就是指想法上的地盤,想法領域侵犯最常發生的情境在於與人產生爭論之際,當兩方意見不同時,視為一種想法上的地盤被侵略。
  收案族群為失智症病人,因疾病關係病人可能出現遺忘或錯認情形,照顧者常從旁糾正,故雙方想法衝突,人類受文化與教育影響會採協商溝通,但是失智症病人可能因疾病無法以言語表達需求,轉而以非語言方式表達,也就是所謂的躁動行為(agitation behavior)。20-50%失智症病人有躁動行為表現,照顧者疲於應付,本研究目的為了解想法領域侵犯對失智症病人的影響,做為失智症照護方式之改善。
  本研究採取實驗組與對照組實驗介入前後對照方式,實驗共兩項,第一項實驗為牛頭不對馬嘴實驗,實驗設計為觀看影像與聲音違和的影片,以產生想法領域上的衝突落差,第二項實驗為指鹿為馬實驗,為問答形式,回答後立即以〝X〞影像與錯誤音效產生否定刺激,實驗過程變項蒐集心跳變異程度(Heart rate variability, HRV)與身體壓力中心改變(center of pressure variability, COPV)作為躁動行為評估指標。研究假設為想法領域受侵犯時失智症病人心跳變異比認知健康者低、身體壓力中心變異大。
研究結果發現實驗一僅認知健康組心跳變異上升,可能為研究設計無法產生適當想法領域侵犯刺激及研究流程設計設計問題,此可作為未來研究改善之參考;實驗二實驗效度高,失智症組比認知健康組身體壓力中心變異大,符合部分研究假設,顯示想法領域受侵犯時失智症病人躁動行為較認知健康者顯著,照護時應注重病人之領域建立。
英文摘要 Background:Territory refers to the defense area in space or belief. Violation of territory will result in defense behavior. The theory and practice are based on animal behavior, and territory is a unique form of human beings. This study is focus on dementia patients whose behavior and cognitive often negatived by caregiver due to characteristic of disease. Meanwhile, it is a sort of violation of territory for dementia patients. According to clinical observation, violation of territory is closely related to agitated behavior. Hence, the purpose of the research is to discuss the effect of territory offenses and agitated behavior in dementia patients.

Method:There were normal control group and dementia group respectively. A cross-over design was adopted, including two tests. Film and questions were given in order to simulate the situation of violation of territory. Test 1-This test is to create cognitive conflict by watching video stream which the images doesn’t match the sound. Test 2 - Question and Answer is conducted in test 2 and the video would immediately display the false sign “X” and sound. Observe patients’ behaviors while the false sign and sound generated. Heart rate variability (HRV) and center of pressure variability (COPV) were applied to evaluate agitated behavior. HRV monitor and Wii Balance Board were utilized to measure physical and behavior orientation of aggressive and non-aggressive behavior respectively.

Results:The dementia patients are prone to generate agitated behavior when their territory is violated. That is, the dementia patients are more aggressive than others which indicate higher changes of COPV mean that non-aggressive behavior happened intensively.

Conclusion:According to Sigmund Freud’s personality construct theory, super-ego and ego are constrained by ethical standards. Communication and negotiation are methods used by super-ego and ego for achieving a balance while they faced violation of territory. As for the dementia patients, they behave directly without cover owing to the return of Id on personality development. Thus, they are relatively easy to agitate when encountering violation of territory. As a result, the dementia patient needs more respect in different area compare with normal people. And this can adopted to improve care in the further.
論文目次 第一章、前言1
第二章、文獻回顧2
第一節、領域2
壹、領域定義3
一、防禦區域3
二、排除區域4
三、區位優勢4
貳、領域行為5
一、囓齒動物領域行為5
二、人類領域行為5
第二節、失智症疾病特性與躁動行為8
第三節、研究目的10
第三章、研究方法12
第一節、研究流程12
第二節、研究對象14
壹、具失智症診斷(實驗組)15
貳、能自行行走站立、視力聽力良好、無心律不整(實驗組、對照組)16
第三節、研究設計17
壹、實驗一:牛頭不對馬嘴測驗17
貳、實驗二:指鹿為馬測驗18
第四節、研究變項19
壹、人口學變項19
貳、生理指標-心跳變異(Heart rate variability, HRV)21
參、行為指標-身體壓力中心22
肆、實驗效度23
第四章、研究結果24
第一節、人口學變項24
第二節、實驗效度28
壹、實驗一-牛頭不對馬嘴實驗效度28
貳、實驗二-指鹿為馬實驗效度29
參、實驗效度組間比較30
第三節、生理變項-心跳變異32
壹、前測與實驗一每分鐘心跳數有無差異32
貳、前測與實驗二每分鐘心跳數有無差異33
參、前測與實驗一心跳變異有無差34
肆、前測與實驗二心跳變異有無差異35
伍、NPI 分數能否預測心跳變異改變37
第四節、行為變項-身體壓力中心39
壹、前測與實驗一身體壓力中心移動距離有無差異39
貳、前測與實驗二身體壓力中心移動距離有無差異40
參、前測與實驗一身體壓力中心移動距離變異有無差異41
肆、前測與實驗二身體壓力中心移動距離變異有無差異42
伍、 NPI分數能否預測身體壓力中心改變44
第五章、討論與結論46
第一節、人口學變項討論46
第二節、實驗一討論47
第三節、實驗二討論48
第四節、綜合討論50
第五節、領域維護照護措施53
壹、機構評估53
貳、領域階層性56
參、領域維護照護措施63
第六節、研究限制、未來研究方向與結論64
參考文獻65
附錄一 臨床經驗與研究啟發69
附錄二 同意臨床試驗證明書73
附錄三 個案初步篩選評估表74
附錄四 收案總表76
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英文部分
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