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系統識別號 U0026-1806201211143800
論文名稱(中文) 運用參與式行動研究提升長期照護經皮內視鏡胃造口的使用
論文名稱(英文) An Participatory Action Research to Enhance Percutaneous Endoscopic Gastrostomy Appropriate Use in Long Term Care
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 100
學期 2
出版年 101
研究生(中文) 葉莉莉
研究生(英文) Li-Ly Yeh
學號 TA8921021
學位類別 博士
語文別 中文
論文頁數 237頁
口試委員 指導教授-陳清惠
口試委員-林麗嬋
口試委員-蔣欣欣
口試委員-施陳美津
口試委員-盧豐華
中文關鍵字 胃造口  參與式行動研究  夥伴 
英文關鍵字 Percutaneous endoscopic gastrostomy  participatory action research  partner 
學科別分類
中文摘要 國內研究顯示腸道營養支持,是長期照護服務中需求最大的照護項目。1980年經皮內視鏡胃造口(percutaneous endoscopic gastrostomy,以下簡稱胃造口)於西方國家推展,需長期腸道營養支持者,現有文獻顯示使用胃造口的成果優於鼻胃管。台灣從1994年引入此技術,惟十多年來在長期照護體系中難以推廣,本計畫應用參與式行動研究,組成胃造口推廣中心,建置各式衛教資源,含單張、手冊、海報、影片及教育訓練教材等,供人員教育訓練使用。
計畫執行的第一階段(2008.12~2009.5)為試行期,與六機構組成夥伴,在參與合作及賦權過程中,建立胃造口推動方案。第二年擴大夥伴招募,總計執行期間有62個夥伴加入。夥伴的推廣行動包括在結構面研擬計劃與推廣政策,設計流程與表單,過程面進行人員的教育訓練與照顧者的推廣活動,結果傳遞胃造口訊息給約6000人;26個夥伴機構共執行309個胃造口處置,平均胃造口個案佔長期灌食者5.78%,其中177位改用胃造口病人的胃出血、再入院與約束等問題顯著低於鼻胃管放置時。統計分析顯示夥伴為醫院類型、有研擬推廣政策、發展相關流程及定期做胃造口適切評估者,其胃造口個案較多(p < .05);加入前有胃造口個案、有合作醫院、尋求中心協助、有辦教育訓練及使用適切性評估單的夥伴成果也較佳(p < .01)。 另由問卷及焦點訪談顯示衛教資源對推廣的助益大、中心與夥伴對「夥伴關係」相互給予高度評價、夥伴有賦權及能力培養感受、產出學術成果20篇、且近乎所有機構表達計劃結束後持續推動的可能性。
英文摘要 Percutaneous endoscopic gastrostomy (PEG) feeding, introduced in 1980, has been a common device used in western societies for more than twenty years. However, its use is not as popular in Taiwan. The purpose of this research was to enhance PEG use through participatory action research (PAR). We set up a PEG center and developed variety of educational material, including pamphlet, poster, and video for professionals and public. Initial stage: Six agencies joined the program and took actions to enhance PEG tube use in their praxis. In the following year, 62 agencies joined the PAR program. Outcome analysis showed that in the structure dimension, most of the agencies developed policy and procedures to enhance PEG use. In the process dimension, about 6000 people received PEG information. A total of 309 PEG devices has been done by 26 agencies, and those who received PEG feeding (n=177) had better life quality (less GI bleeding, rehospitalization, and physical restraint). The average proportion of PEG use was 5.78%. Both parties appreciated the partnership built in the process. All except one partner expressed the willingness to continue the actions to enhance the appropriate use of PEG tube.
論文目次 摘要 I
Abstract II
誌謝 III
表目錄 IX
圖目錄 XI
第一章 緒論 1
第一節 研究的問題意識與動機 1
第二節 護理科學知識發展的目的 3
第三節、研究者執行與本研究相關的前驅研究 5
一、長期照護服務中腸道營養支持照護之探討 5
二、國科會三年計劃 6
第四節 實踐改變的研究典範-參與式行動研究 9
第五節 研究目的與研究問題 10
第二章 文獻查證 13
第一節 西方胃造口相關研究 13
一、使用鼻胃管與胃造口病人成果之比較 13
二、中風病人使用胃造口之長期成果 15
三、胃造口病人/照護者的生活經驗 16
第二節 台灣胃造口相關文獻與研究 17
第三節 參與式行動研究法 22
一、參與式行動研究的源起與發展 23
二、參與式行動研究的定義、特質及分類 24
三、參與式行動研究中的夥伴關係 27
四、參與式行動研究的實作策略 28
五、參與式行動研究於護理專業的應用 31
第三章 方法論 37
第一節 後現代主義與護理知識建構 37
第二節 參與式行動研究法的認識論及其權力 40
一、參與式行動研究的認識論 40
二、權力與參與式行動研究 42
第三節 健康服務的有效性及其研究 43
第四章 研究方法 46
第一節 胃造口夥伴計劃目的與夥伴招募 46
一、胃造口夥伴計劃目的 46
二、夥伴招募與夥伴類別 46
第二節 胃造口教育訓練與行動資源發展 52
一、胃造口教育媒介 52
二、專業人員教育訓練規劃 55
三、胃造口夥伴的行動資源 56
第三節 資料收集與分析 59
一、中心文件檔案 59
二、夥伴成果調查 64
三、夥伴關係評值 68
四、夥伴焦點訪談 71
第四節 研究嚴謹度 72
一、效度 72
二、研究確實性的檢視 74
第五節 倫理考量 74
一、自主原則 75
二、不傷害原則 75
三、行善原則 77
四、公平正義原則 77
第六節 研究者的準備 78
一、研究者於長照實務與學術背景 78
二、研究者於參與式行動研究的實務與學術準備 79
第五章 研究結果 81
第一節 本研究號召的參與夥伴 81
一、夥伴機構基本資料 82
二、夥伴機構推動者特質 86
第二節 夥伴推動胃造口適切應用之結構面、過程面與結果面 88
一、夥伴機構胃造口推動的結構面 88
二、夥伴機構胃造口推動的過程面 89
三、夥伴機構推動胃造口適切應用之結果面 94
第三節 胃造口個案特質 108
第四節 中心與夥伴對夥伴關係的評值 112
一、中心對夥伴關係的評值 112
二、夥伴對夥伴關係的評值 115
三、比較中心與夥伴對夥伴關係評值 117
第五節 夥伴焦點訪談 117
一、夥伴機構推動者對參與本研究的感受、經驗的改變,對個人/機構的影響 118
二、中心所運用的策略及各式發展資源對夥伴推動胃造口的影響 122
三、夥伴計劃結束後持續行動的想法 125
四、對學術界與實務機構形成夥伴關係的看法 126
第六章 討論 128
第一節 誰加入夥伴?為何加入? 128
一、夥伴是誰 128
二、夥伴為何加入計劃 130
第二節 參與式行動研究改變了什麼?改變如何發生? 132
一、參與式行動研究改變了什麼 132
二、改變如何發生 135
第三節 參與式行動研究法在提升胃造口適切應用的意義 142
一、激發行動者的反思與賦權感受 143
二、參與式行動研究具有彈性可對應現況需求 143
三、參與式行動研究具有向未來開展的特質 144
四、參與式行動研究重視實務工作者的知識生產 145
第四節 研究限制 145
一、夥伴機構參與狀況及組織特性影響結果 145
二、其他因素影響結果 146
三、研究結果再現的有限性 147
第七章 結論與建議 149
第一節 結論 149
第二節 建議 150
一、臨床實務 150
二、專業教育 152
三、未來研究 153
參考書目 154
經皮膚內視鏡胃造口(PEG) 171
推廣計畫資源手冊 171
附錄 212
附錄一、 臺閩地區長照機構類型定義 212
附錄二、 PDSA報告格式 213
附錄三、 期末成果調查表 214
附錄四、 中心紀錄與夥伴參與 220
附錄五、 各夥伴機構聯繫重點與內容 224
附錄六、 胃造口個案調查表 231
附錄七、 夥伴關係評值 232
附錄八、 中心對夥伴關係評值評分標準 233
附錄九、 受試者同意書 235
附錄十、 人體試驗委員會同意書 237
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