题名

病患親屬健康識能的自我導向學習－以一個腹膜透析患者家庭為例

并列篇名

The Self-Directed Learning of the Health Literacy in the Family －A Case Study of the Family with a Patient Needing Peritoneal Dialysis

作者

王政彥(Cheng-yen Wang)；方珮珍(Pei-chen Fang)

关键词

自我導向學習 ； 健康識能 ； 腹膜透析 ； Health literacy ； self-directed learning ； peritoneal dialysis

期刊名称

高雄師大學報：教育與社會科學類

卷期/出版年月

45期（2018 / 12 / 01）

页次

1 - 33

内容语文

繁體中文
中文摘要

臺灣洗腎人口密度高居世界第一，在治療及照護過程中，患者親屬的角色甚為重要，但臺灣病患親屬健康識能的自我導向學習相關研究闕如。本研究旨在探討腹膜透析患者親屬健康識能的自我導向學習歷程，瞭解其學習動機、健康識能內涵、學習策略、阻礙與突破。以一個長期腹膜透析個案家庭為研究對象，採半結構式深度訪談法訪談其中五位成員。研究結果發現：(一)生命任務賦予照護責任，患者病情轉變時為關鍵學習高峰期；(二)自我導向培力越深，有助催化出高層次健康識能內涵；(三)發展自我導向學習策略系統，建構回饋循環的學習迴路；(四)家庭合作學習網絡克服困境，帶動親友健康識能提升。本研究檢視親屬健康識能之提升過程與學習策略，為增強臺灣病患親屬健康識能及縮短學習歷程方案設計提供重要資訊。
英文摘要

The prevalence of the dialysis patients in Taiwan is highest in the world. In the course of treatment and care, the role of patients' family is very important. But the reports of the self-directed learning of the health literacy in the patients' family are little in Taiwan. This study investigated the self-directed learning process of one peritoneal dialysis patient's family members. This study tried to understand their motivation, the health literacy change, the learning strategies, the obstacles and breakthroughs. The case chosen for this study was a family with a patient needing long-term peritoneal dialysis. The one-to-one semi-structured interview was conducted with the 5 members of the family. The results of the study are: (1) The care responsibility is deemed as the life task. When the patient's physical condition changes, it is the key point and the peak of learning. (2) The higher self-directed empowerment accelerates the evolvement of the health literacy. (3) The learning strategy is to develop the self-directed learning system and construct a feedback learning loop. (4) The co-operative family learning network can overcome the difficulties and improve the health literacy of the associated relatives and friends. This study explored the family's health literacy evolvement and the learning strategy. The results provide important information to the future projects design, which improves the health literacy and shortens the learning process of the patients' family in Taiwan.
主题分类 人文學 > 人文學綜合
社會科學 > 社會科學綜合
社會科學 > 教育學
参考文献
  1. 何玉瑛、葉德豐、張育嘉、陳呈旭、陳錦華(2012)。影響慢性腎臟病患定期回診因素及定期回診對病程變化的效益。醫務管理期刊，13(3)，147-161。
    連結：
  2. 何青蓉(2015)。健康識能課程與教學實踐探究：批判性識讀觀點。高雄師大學報：教育與社會科學類，39，73-98。
    連結：
  3. 林季緯、何青蓉、黃如薏、王維典(2016)。健康識能的概念發展與實務應用。臺灣家庭醫學雜誌，26(2)，65-76。
    連結：
  4. 顏妙芬、李佩玉、蔡惠貞(2016)。重要關鍵人幫忙關係於慢性腎臟病患照護—策略及應用。護理雜誌，63(2)，19-25。
    連結：
  5. 羅玉玲、黃詩珮、謝玉如(2017)。協助一位單身女性正向面對初次透析治療之護理經驗。臺灣腎臟護理學會雜誌，16(1)，70-84。
    連結：
  6. Adelman, R. D.,Tmanova, L. L.,Delgado, D.,Dion, S.,Lachs, M. S.(2014).Caregiver burden: A clinical review.Jama,311(10),1052-1060.
  7. American Medical Association(1999).Health literacy: Report of the Council on Scientific Affairs.Journal of the American Medical Association,281(6),552-557.
  8. Bonner, A.,Havas, K.,Douglas, C.,Thepha, T.,Bennett, P.,Clark, R.(2014).Self‐management programmes in stages 1-4 chronic kidney disease: A literature review.Journal of Renal Care,40(3),194-204.
  9. Brey, R. A.,Clark, S. E.,Wantz, M. S.(2007).Enhancing health literacy through accessing health information, products, and services: An exercise for children and adolescents.Journal of School Health,77(9),640-644.
  10. Brockett, R. G.,Hiemstra, R.(1991).Self-direction in adult learning: Perspectives on theory, research, and practice.New York, NY:Routledge.
  11. Brookfield, S.(1985).Self-directed learning: From theory to practice.San Francisco, CA:Jossey-Bass.
  12. Brookfield, S. D.(1986).Understanding and facilitating adult learning: A comprehensive analysis of principles and effective practices.San Francisco, CA:Jossey-Bass.
  13. Campbell, Z. C.,Stevenson, J. K.,McCaffery, K. J.,Jansen, J.,Campbell, K. L.,Lee, V. W.,Webster, A. C.(2016).Interventions for improving health literacy in people with chronic kidney disease.Cochrane Database of Systematic Reviews,2,1-13.
  14. Candy, P. C.(1991).Self-direction for lifelong learning: A comprehensive guide to theory and practice.San Francisco, CA:Jossey-Bass.
  15. Cavanaugh, K. L.,Wingard, R. L.,Hakim, R. M.,Eden, S.,Shintani, A.,Wallston, K. A.,Ikizler, T. A.(2010).Low health literacy associates with increased mortality in ESRD.Journal of the American Society of Nephrology,21(11),1979-1985.
  16. Cong, Y.(2004).Doctor-family-patient relationship: The chinese paradigm of informed consent.The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine,29(2),149-178.
  17. Cutilli, C. C.,Bennett, I. M.(2009).Understanding the health literacy of America results of the national assessment of adult literacy.Orthopaedic nursing,28(1),27-34.
  18. Daly, G.(1995).New York,Teachers College, Columbia University.
  19. Dennis, R. J.(2017).Department of Educational Research and Administration, The University of Southern Mississippi.
  20. Devraj, R.,Gordon, E. J.(2009).Health literacy and kidney disease: Toward a new line of research.American Journal of Kidney Diseases,53(5),884-889.
  21. Doddato, T. M.(1996).New York,Columbia University.
  22. Fan, R.(1997).Self‐determination vs. family‐determination: Two incommensurable principles of autonomy.Bioethics,11(3-4),309-322.
  23. Freedman, A. M.,Echt, K. V.,Cooper, H. L. F.,Miner, K. R.,Parker, R.(2012).Better learning through instructional science: A health literacy case study in "How to teach so learners can learn".Health Promotion Practice,13(5),648-656.
  24. Garrison, D. R.(1997).Self-directed learning: Toward a comprehensive model.Adult education quarterly,48(1),18-33.
  25. George, R. V.(1994).Virginia Polytechnic Institute and State University.
  26. Glanz, K.,Rimer, B. K.,Viswanath, K.(2008).Health behavior and health education: theory, research, and practice.San Francisco, CA:Jossey-Bass.
  27. Goetz, E. T.(Ed.),Alexander, P. A.(Ed.)(1988).Learning and Study Strategies.San Diego, CA:Academic Press.
  28. Golper, T.(2001).Patient education: can it maximize the success of therapy?.Nephrology Dialysis Transplantation,16(suppl-7),20-24.
  29. Goudas, M.,Biddle, S.,Underwood, M.(1995).A prospective study of the relationships between motivational orientations and perceived competence with intrinsic motivation and achievement in a teacher education course.Educational Psychology,15(1),89-96.
  30. Green, J. A.,Mor, M. K.,Shields, A. M.,Sevick, M. A.,Arnold, R. M.,Palevsky, P. M.,Weisbord, S. D.(2013).Associations of health literacy with dialysis adherence and health resource utilization in patients receiving maintenance hemodialysis.American Journal of Kidney Diseases,62(1),73-80.
  31. Harrington, M.(2015).Health literacy in children with chronic kidney disease and their caregivers.Nephrology Nursing Journal,42(1),53-57.
  32. Hebert, L. A.,Wilmer, W. A.,Falkenhain, M. E.,Ladson-Wofford, S. E.,Nahman, N. S.,Rovin, B. H.(2001).Renoprotection: one or many therapies?.Kidney international,59(4),1211-1226.
  33. Hill, L. H.(2004).Health literacy is a social justice issue that affects us all.Adult Learning,15(1-2),4-6.
  34. Himmelfarb, J.,Kliger, A. S.(2007).End-stage renal disease measures of quality.Annual Review of Medicine,58,387-399.
  35. Institute of Medicine(2004).Health literacy: A prescription to end confusion.Washington DC:National Academies Press.
  36. Jaffery, J. B.,Becker, B. N.(2004).Evaluation of eHealth web sites for patients with chronic kidney disease.American Journal of Kidney Diseases,44(1),71-76.
  37. Jarvis, P.(1987).Meaningful and meaningless experience: Towards an analysis of learning from life.Adult Education Quarterly,37(3),164-172.
  38. Jeffery, R. W.(2004).How can health behavior theory be made more useful for intervention research?.International Journal of Behavioral Nutrition and Physical Activity,1(1),10-14.
  39. Joint Committee on National Health Education Standards(1995).National health education standards: Achieving health literacy.Atlanta, GA:American Cancer Society.
  40. Kazley, A. S.,Hund, J. J.,Simpson, K. N.,Chavin, K.,Baliga, P.(2015).Health literacy and kidney transplant outcomes.Progress in Transplantation,25(1),85-90.
  41. Knowles, M.(1973).The adult learner: A neglected species.Houston, TX:Gulf.
  42. Knowles, M. S.(1975).Self-directed learning.New York, NY:Association Press.
  43. Knowles, M. S.(1989).The making of an adult educator: An autobiographical journey.San Francisco, CA:Jossey-Bass.
  44. Lai, A. Y.,Ishikawa, H.,Kiuchi, T.,Mooppil, N.,Griva, K.(2013).Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis.Patient Education and Counseling,91(2),221-227.
  45. Martinez, C. H.,Moy, M. L.,Nguyen, H. Q.,Cohen, M.,Kadri, R.,Roman, P.,Giardino, N. D.(2014).Taking Healthy Steps: rationale, design and baseline characteristics of a randomized trial of a pedometer-based Internet-mediated walking program in veterans with chronic obstructive pulmonary disease.BMC Pulmonary Medicine,14(1),12.
  46. Merriam, S.(Ed.),Caggarella, R.(Ed.)(1999).Learning in adulthood: A comprehensive guide.San Francisco; CA:Jossy-Bass.
  47. Meuleman, Y.,Ten Brinke, L.,Kwakernaak, A. J.,Vogt, L.,Rotmans, J. I.,Bos, W. J. W.,Hoekstra, T.(2015).Perceived barriers and support strategies for reducing sodium intake in patients with chronic kidney disease: A qualitative study.International Journal of Behavioral Medicine,22(4),530-539.
  48. Murphy-Ende, K.(1997).Madison,The University of Wisconsin.
  49. Nutbeam, D.(2008).The evolving concept of health literacy.Social Science & Medicine,67(12),2072-2078.
  50. Nutbeam, D.(2000).Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century.Health Promotion International,15(3),259-267.
  51. Oermann, M. H.,Wilson, F. L.(2000).Quality of care information for consumers on the Internet.Journal of nursing care quality,14(4),45-54.
  52. Parker, R. M.,Ratzan, S. C.,Lurie, N.(2003).Health literacy: A policy challenge for advancing high-quality health care.Health Affairs,22(4),147-153.
  53. Parker, R.,Ratzan, S. C.(2010).Health literacy: A second decade of distinction for Americans.Journal of health communication,15(S2),20-33.
  54. Prochaska, J. O.,DiClemente, C. C.(1982).Transtheoretical therapy: Toward a more integrative model of change.Psychotherapy: theory, research & practice,19(3),276-288.
  55. Rogers, C. R.(1983).Freedom to learn for the 80's.Ohio, US:Merrill.
  56. Rothman, A. J.(2004).Is there nothing more practical than a good theory?: Why innovations and advances in health behavior change will arise if interventions are used to test and refine theory.International Journal of Behavioral Nutrition and Physical Activity,1(11),1-7.
  57. Sørensen, K.,Van den Broucke, S.,Fullam, J.,Doyle, G.,Pelikan, J.,Slonska, Z.,Brand, H.(2012).Health literacy and public health: A systematic review and integration of definitions and models.BMC Public Health,12(1),80-92.
  58. Tough, A. M.(1979).The adult's learning project.Toronto, Canada:The Ontario Institute for Studies in Education.
  59. USRDA(2017).US Renal Data System 2017 annual data report: Epidemiology of kidney disease in the United States.Bethesda, MD:National Institute of Diabetes and Digestive and Kidney Diseases.
  60. Verwey, R.,van der Weegen, S.,Spreeuwenberg, M.,Tange, H.,van der Weijden, T.,de Witte, L.(2014).A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial.BMC Family Practice,15(1),93-102.
  61. Wavamunno, M. D.,Harris, D. C.(2005).The need for early nephrology referral.Kidney international,67,128-132.
  62. Welch, J. L.,Johnson, M.,Zimmerman, L.,Russell, C. L.,Perkins, S. M.,Decker, B. S.(2015).Self-management interventions in stages 1 to 4 chronic kidney disease: An integrative review.Western Journal of Nursing Research,37(5),652-678.
  63. Williams, M. V.,Davis, T.,Parker, R. M.,Weiss, B. D.(2002).The role of health literacy in patient-physician communication.Family Medicine-Kansas City,34(5),383-389.
  64. World Health Organization(1998).Health promotion glossary.
  65. Zala, P.,Rütti, G.,Arampatzis, S.,Spichiger, E.(2017).Experiences of patients with chronic kidney disease and their family members in an advanced practice nurse-led counseling service.Nephrology Nursing Journal,44(6),521-543.
  66. 王英偉、魏米秀、張美娟(2017)。健康識能與醫病共享決策。醫療品質雜誌，11(4)，42-49。
  67. 李雅慧、葉俊廷(2014)。多元形式的學習參與：成人自我導向學習的觀點及其應用。T & D 飛訊，182，1-20。
  68. 邱慧禎、顏妙芬、陳清惠、陳立祥(2009)。探討慢性腎臟疾病網站品質現況。護理暨健康照護研究，5(2)，129-139。
  69. 洪聖惠、柯彤文、許瑋庭、朱嘉琳、王拔群(2017)。病家參與新利器～談醫病共享決策。醫療品質雜誌，7(1)，36-34。
  70. 胡潔瑩、林秋菊(1999)。末期腎臟疾病患者面對透析治療方法的抉擇衝突。腎臟與透析，11(2)，106-207。
  71. 張武修(2017，9 月7 日)。公立醫院如何提升民眾「健康識能」？。民報。取自http://www.peoplenews.tw/news/91612e78-e0d3-4498-a6e4-601484a46308
  72. 張美娟、陳月枝、章淑娟(2009)。健康素養的概念分析。護理雜誌，56(5)，93-97。
  73. 張麗春(2008)。健康素養─評價衛生教育計畫成效的新指標。護理雜誌，55(1)，81-86。
  74. 梁嘉慧、楊勤熒、盧國城、朱柏齡、陳瓊華、謝湘俐(2008)。慢性腎臟疾病患者選擇腹膜透析模式影響之因素。臺灣腎臟護理學會雜誌，7(2)，1-9。
  75. 陳茂祥(2001)。自我導向學習理論及其在成人教育上的啟示。朝陽科技大學學報，6，65-89。
  76. 陳慶如(2011)。碩士論文(碩士論文)。臺中市，中國醫藥大學社會醫學護理學系。
  77. 陸嬌陽、翁淑滿、邱玫月、曾秀琴、楊雅芳、陳瓊瑤(2010)。改善腹膜透析病患發生腹膜炎之認知與技能專案。臺灣腎臟護理學會雜誌，9(1)，17-32。
  78. 趙康邑、王實之、黃遵誠、翁林仲、李光申、璩大成(2017)。北市聯醫推廣健康識能之現況。北市醫學雜誌，14(2)，224-233。
  79. 劉月敏、謝湘俐、駱敏淑、馬麗卿、張宏哲(2010)。血液透析患者的復原力與社會支持。臺灣腎臟護理學會雜誌，9(1)，33-43。
  80. 蔡淑梅、梁嘉慧、謝湘俐(2011)。一位腹膜透析患者學習自我照顧之護理經驗。臺灣腎臟護理學會雜誌，10(1)，31-41。
  81. 蔡慈儀、蔡憶文、郭耿南(2010)。醫療照顧體系中的健康溝通。臺灣醫學，14(6)，607-615。
  82. 鄭惠美(1997)。不同型式自我導向學習對高血壓防治知識之效果研究。師大學報：教育類，42，95-111。
  83. 鄭惠美(2001)。應用自我導向學習策略培養社區志工—以台北縣雙溪鄉社區健康營造中心為例。護理雜誌，48(1)，43-48。
  84. 蘇哲能、張淑鳳、陳榮基、潘豐泉、陳清軒、劉偉文(2008)。臺灣健康知能量表之初探性研究。臺灣醫學，12(5)，525-536。
被引用次数
  1. 戴慧如,陳殷哲,何世華(2021)。自我導向學習之統合分析研究。科技與人力教育季刊，7(4)，109-126。
  2. 鍾惠君,戴佳惠,鄭雅君,陳建皓,張美侖,呂基燕(2022)。改善內科住院病人防跌措施的完整性－病人參與策略的運用。志為護理-慈濟護理雜誌，21(5)，70-81。
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