政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/94751
English  |  正體中文  |  简体中文  |  Post-Print筆數 : 27 |  全文笔数/总笔数 : 113160/144130 (79%)
造访人次 : 50753478      在线人数 : 709
RC Version 6.0 © Powered By DSPACE, MIT. Enhanced by NTU Library IR team.
搜寻范围 查询小技巧：
  • 您可在西文检索词汇前后加上"双引号"，以获取较精准的检索结果
  • 若欲以作者姓名搜寻，建议至进阶搜寻限定作者字段，可获得较完整数据
    •  进阶搜寻
    政大機構典藏 > 商學院 > 資訊管理學系 > 學位論文 >  Item 140.119/94751


    请使用永久网址来引用或连结此文件: https://nccur.lib.nccu.edu.tw/handle/140.119/94751


    题名: 以民族誌決策樹與模糊本體論法研究失智症照護之供需
    Investigation of the long-term institutional care requirements of patients with dementia and their families by qualitative and quantitative analysis
    作者: 張清為
    Chang, Chingwei
    贡献者: 季延平
    方國定
    Chi, Yenping
    Fnag, Kwoting
    張清為
    Chang, Chingwei
    关键词: 老人失智照護
    民族誌決策樹
    模糊本體論分析
    Senile dementia care
    Ethnographic decision tree model
    Ontology-based fuzzy clustering
    日期: 2008
    上传时间: 2016-05-09 11:46:34 (UTC+8)
    摘要: 台灣在過去的數十年內，罹患失智症人口逐漸增多，其中的多數皆有接受了各層面的照護，舉凡藥物治療、醫護治療、復健治療以及職能治療，然其中的成效與需求之研究仍相當缺乏。故本研究採以質性與量性研究方法，以便於探索目前失智症患者家屬照護時所面臨的實際抉擇歷程與主要需求，並同時探索個案醫院內的治療效果與病患入院時狀況之關係，本研究希望藉由中部地區失智症病患照護的需求及機構之供給的角度來探索研究所能增進其醫療服務品質之處。
    在質性研究方法部分，本研究以民族誌決策樹研究法來洞悉與探索家屬在面臨照護失智症病患時是否要採行機構式照護的決策歷程以及決策條件。藉由深度訪談結果粹取出的判斷準則發現，影響家屬決策之最主要考量為失智症病患者的失智程度，其餘包含道德規範、照護負擔、病患是否需要騎他的專業醫療照護以及照護中心的軟硬體環境。本研究整合考量這些判斷準則的優先順序、輕重緩急以及因果關係後將之建立決策樹，並以另外五十名家屬驗證該模型之預測力，得到預測準確率為92%。
    此外，本研究再以量性方法來探索治療對於不同失智症病患的成效。結果顯示入住時狀況較好的失智症住民會以更積極的態度來接受職能治療，也因此他們擁有較大的改善或控制病情的機會，然而當住民以消極的態度接受職能治療時，則其治療效果遠不及積極治療者，也因此病情退步的機會較大，主要原因在於多數情況較差的住民具有攻擊、抗拒治療的傾向，使得照護工作變得更為艱鉅，故本研究建議家屬應重視職能治療以及與病人互動之重要性，不論是在居家照護亦或是機構式照護
    Over the past decade, the number of long-term care (LTC) residents has increased, and many have accepted treatments such as medication, rehabilitation and occupational therapy. This study employs both qualitative and quantitative techniques in order to discuss senile dementia patient care in long-term care institutions, and we use a supply and demand viewpoint to explore what services are really necessary for the patient and their family.
    In qualitative method, the main purpose of this stage is to use the ethnographic decision tree model to understand and explore the decision criteria of the subject. Our study found that the degree of dementia of the patient always affects the decisions made by family members – in fact, this is the most important of all criteria elicited from the interviews with family members. There are also ethical constraints, care burden, norm of filial obligation, patient need professional medical care and institutional environment, etc. which mentioned by families. We linked together the decision criteria considered most important in accounting for the decision-making sequence of family members to be the ethnographic decision tree model which predictive power is 92%.
    In quantitative stage, our study discussed the effectiveness of occupational therapy when given to dementia patients of different contexts. The results of this stage showed that patients of a good condition in the first stage present a more positive attitude towards participation in the occupational therapy designed by the institution; therefore, they have a greater chance of their condition improving or remaining the same. However, patients of an average condition have a more passive attitude towards taking part in any therapy; therefore, they have a greater chance of their condition deteriorating, because of their violent tendencies and their resistance to care, the task of caring for these patients is more difficult than caring for patients in the other groups. Above all, we suggest that families adopt the therapies no matter in homecare or institutionalization, as early as possible in order to improve the likelihood of being able to control the patient’s condition. It is understandable that accepting more therapies and interaction in the early stage of dementia, having higher chance to go well, however, by waiting until then they also miss the best opportunity to attempt to improve the patient’s condition, it is really not the good way we suggest to be.
    參考文獻: 1 Arai Y, Washio M. 1999, Burden felt by family caring for the elderly members needing care in southern Japan, Aging Ment Health, vol.3, pp.158–164.
    2. Barthel DW, Mahoney FI. 1965, Functional evaluation: the Barthel index. MD State Med Journal, Vol.14, pp.61–5.
    3. Cervilla JA, Prince MJ. 1997, Cognitive impairment and social distress as different pathways to depression in the elderly: a cross-sectional study, Int J Geriatr Psychiatry, vol.12, pp. 995–1000.
    4. Claudia Leacock, Martin Chodorow. Combining local context and WordNet similarity for word sense identification. In Fellbaum, 1998, pp. 265–283.
    5. Cockrell JR and Folstein MF Mini Mental State Examination (MMSE), Psychopharmacology, 1998, vol.24, pp. 689-692.
    6. Consensus report of the Working Group on Molecular and Biochemical Markers of Alzheimer’s Disease, 1998, The Ronald and Nancy Reagan Research Institute of the Alzheimer’s Association and the National Institute on Aging Working Group, Neurobiol. Aging 19, pp. 109–116.
    7. Daniel I. Kaufer, MD. 2001, Long-Term Care in Dementia:Patients and Caregivers, Clinical Cornerstone, vol.3, Issue: 4, pp. 52-62.
    8. Dekang Lin. 1998, An information-theoretic definition of similarity. In Proceedings of the 15th International Conference on Machine Learning, Madison,WI.
    9. Fabrigoule C, Letenneur L, Dartigues JF, Zarrouk M, Commenges D, Barberger-Gateau P. 1995, Social and leisure activities and risk of dementia: a prospective longitudinal study. J Am Geriatr Soc, vol.43, pp. 485–90.
    10. Ferri CP, Prince M, Brayne C, et al. 2005, Global prevalence of dementia: a Delphi consensus study. Lancet, vol.366, pp. 2112–17.
    11. Fielding N. Ethnography. 1993, In: Gilbert GN, editor. Researching social life. London: Sage Publications, pp.154–171.
    12. Folstein MF, Folstein SE, McHugh PR. 1975, Mini-Mental State`A practical method for grading the cognitive state of patients for the clinician, J Psychiatr, Res 12, pp.189–198.
    13. Garro L. 1986, Decision-making models of treatment choice. In : Mchugh S, Vallis TM, eds. Illness behavior : a multidisciplinary model. New York: Plenum, pp.173-88.
    14. Gladwin CH, 1989, Ethnographic decision tree modeling: qualitative research methods series 19. Newbury Park, CA: Sage.
    15. Gotze, U., 1993, Scenario technique for strategic business planning, second ed. Deutscher University-Verlag,Wiesbaden
    16. Gunilla Nordberg, Anders Wimo, Linus Jonsson, Ingemar Kareholt. 2006, Time use and costs of institutionalised elderly persons with or without dementia: results from the Nordanstig cohort in the Kungsholmen Project—a population based study in Sweden, International Journal of Geriatric Psychiatry, Published online in Wiley InterScience.
    17. Hsiao, S.W. 1994, Fuzzy set theory on car-color design, Color Research and Application, vol.19, pp. 202-213.
    18. Hughes CP, Berg L, Danziger WL, et al, 1982. A new clinical scale for the staging of dementia. Br J Psychiatry, vol.140, pp.566–572.
    19. Ingold T. 2001, The use and abuse of ethnography. Behav Brain, vol.24, Issue:2, pp.337.
    20. Jay J. Jiang. 1997, Semantic Similarity Based on Corpus Statistics and Lexical Taxonomy. In proceedings of international conference research on computational linguistics, Taiwan.
    21. Johnson, R.A., and Wichern, D.W., 1992, Applied multivariate statistical analysis, 3 rd edition, Prentice Hall, Englewood Cliffs. NJ, USA.
    22. Joseph L. Micca, MD, Adam J. Sky, MD, and Linda G. Uhrig-Hitchcock, MD, 2002, “Quality Care: A Practical Guide to Managing Behavioral Symptoms of Dementia”, Journal of the American Medical Directors Association, Vol.3, Issue: 4, Supplement, pp. H21-H25.
    23. Katz S, Ford AB, Moskowitz RW, et al. 1963, Studies of Illness in the Aged. The Index of ADL: a standardized measure of biological and psychosocial function. JAMA, vol.185, pp.914–919.
    24. Kleinman A. 1980, Patients and Healers in the Context of Culture. Berkeley, Calif: University of California Press.
    25. L.A. Zadeh. 1965, Fuzzy sets, Information Control, vol.8, pp.338-353.
    26. Lew, S. K.1995“Filial Piety and Human Society.” In Filial Piety and Future Society, Kyeonggi Province: Academy of Korean Studies, pp.19-36.
    27. L. Fratiglioni, D. De Ronchi, H. Aguero-Torres. 1999, Worldwide prevalence and incidence of dementia, Drugs Aging, vol.15, pp.365–375.
    28. Li, C., 1997. Shifting perspectives: filial morality revisited. Philosophy East and West vol.47, pp.211-232.
    29. Malcolm J. Bond, Michael S. Clark, Suzanne Davies, 2003, The quality of life of spouse dementia caregivers: changes associated with yielding to formal care and widowhood, 2003, Malcolm J. Bond, vol.57, pp.2385-2395.
    30. Martha Holstein. 1997, “Alzheimer’s disease and senile dementia, 1885-1920: an interpretive history of disease negotiation”, Journal of Aging Studies, Vol.11, No.1, pp1-13.
    31. Mcauley, W.J, Travis. S.S, 1997, Position of influence in the nursing home admission decision. Research on Aging, vol.19, pp.26–45.
    32. Michael J Moore, Carolyn W Zhu, Elizabeth C Clipp, 2001, Informal costs of dementia care: Estimates from the National Longitudinal Caregiver Study, The Journals of Gerontology: Series B : Psychological sciences and social sciences. Washington, Vol. 56B, Issue: 4; pg. S219, 10 pgs
    33. Ministry of the Interior R.O.C. Website http://www.moi.gov.tw/english/index.asp
    34. Muecke MA. 1994, On the evaluation of ethnographies. In: Morse JM, editor. Critical issues in qualitative research methods. Thousand Oaks, Calif: Sage Publications, pp. 187–209.
    35. N. C. Berchtold and C. W. Cotman, 1998, "Evolution in the Conceptualization of Dementia and Alzheimer’s Disease: Greco-Roman Period to the 1960s", Neurobiology of Aging, Vol.19, No.3, pp.173-189.
    36. National Institutes of Health website, http://ospp.od.nih.gov/ecostudies/COIreportweb.htm
    37. Neundorfer, M. M., McClendon, M. J., Smyth, K. A., Stuckey, J. C., Strauss, M. E., & Patterson, M. B., 2001, A longitudinal study of the relationship between levels of depression among persons with Alzheimer’s Disease and levels of depression among their family caregivers. Journal of Gerontology: Psychological Sciences, 56B, pp.301-313.
    38. Nolan, M., Walker, G., Nolan, J., Williams, S., Poland, F., Curran, M. & Kent, B.C. 1996, Entry to care: positive choice or fait accomplishment developing a more proactive nursing response to the needs of older people and their carers. Journal of Advanced Nursing, vol.24, pp.265–274.
    39. Patton M, Westby C. Ethnography and Research: A Qualitative View. Topics in Language Disorders 1992;vol.12,issus:3, pp.1–14.
    40. Pepper Commission, Bipartisan Commission on Comprehensive Health Care, 1990, “Why Do We Need Long-Term Care Reform” Washington DC. U.S. Government Printing Office.
    41. Punch KF, 1998, Introduction to social research, quantitative and qualitative approaches. London: Sage Publications.
    42. Punj, G., and Stewart, D.W. 1983, Cluster analysis in marketing research: review and suggestions for application, Journal of Marketing Research, vol.20 (May), pp. 134-148.
    43. Richards, J.A. and Lindesay, J. 1993, Terminal care in old age psychiatry: a survey of professionals’ attitudes and approaches. Psychiatr . Bull., vol.17, pp.207-209.
    44. Richardson, R. and A.F. Smeaton, 1995, “Using WordNet in a Knowledge-Based Approach to Information Retrieval”, Working Paper, CA-0395, School of Computer Applications, Dublin City University, Ireland.
    45. Rudolf Wille, 2005, Formal Concept Analysis as Mathematical Theory of Concepts and Concept Hierarchies”, Formal Concept Analysis, LNAI, vol.3626, pp. 1-33.
    46. Scholz, R.W., Tietje, O., 2002. Embedded Case Study Methods: Integrating Quantitative and Qualitative Knowledge. Sage, Thousand Oaks. pp. xvi+392.
    47. Schultz, R., Beach, S., 1999, Caregiving as a risk factor for mortality: the caregiver health effects study. The Journal of American Medical Association vol.282, pp.2215–2219.
    48. Steinhardt B. 1998, Report to the Secretary of Health and Human Services: Alzheimer’s disease, Estimates of prevalence in the United States, US General Accounting Office, pp 1–45.
    49. Sussna, M., 1993, Word Sense Disambiguation for Free-text Indexing Using a Massive Semantic Network, Proceedings of the Second International Conference on Information and Knowledge Management, CIKM’93, pp.67-74.
    50. Vidich AJ, Lyman SM. 1994, Qualitative methods: Their history and anthropology. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. Thousand Oaks, Calif: Sage Publications, pp.23–59.
    51. Wallace, E. 1994, Psychiatry and its Nosology: A historicao-philosophical Overview, The Johns Hopkins University Press, in Philosophical Perspectives on Psychiatric Diagnostic Categories, edited by J. Sadler, O. Wiggins, and M. Schwartz. Baltimore, pp. 16-86.
    52. Wells, Y. D., & Kendig, H. L. 1996, Changes in carers’ capacity and motivation to provide care. Journal of Family Studies, 2, pp.15–28.
    53. Wimo A, Jonsson L, Winblad B, 2006, An estimate of the worldwide prevalence and direct costs of dementia in 2003. Dement Geriatr Cog Disord, vol.21, pp.175.
    54. Zanetti, O., Bianchetti, A., Frisoni, B., Rozzini, R. and Trabucchi, M. 1993, Determinants of disability in Alzheimer’s disease. Int. J. Geriatr. Psychiatry,vol.8, pp.581-586.
    描述: 博士
    國立政治大學
    資訊管理學系
    91356510
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0913565101
    数据类型: thesis
    显示于类别:[資訊管理學系] 學位論文

    文件中的档案:

    档案 大小格式浏览次数
    index.html0KbHTML2309检视/开启


    在政大典藏中所有的数据项都受到原著作权保护.


    社群 sharing

    著作權政策宣告 Copyright Announcement
    1.本網站之數位內容為國立政治大學所收錄之機構典藏，無償提供學術研究與公眾教育等公益性使用，惟仍請適度，合理使用本網站之內容，以尊重著作權人之權益。商業上之利用，則請先取得著作權人之授權。
    The digital content of this website is part of National Chengchi University Institutional Repository. It provides free access to academic research and public education for non-commercial use. Please utilize it in a proper and reasonable manner and respect the rights of copyright owners. For commercial use, please obtain authorization from the copyright owner in advance.

    2.本網站之製作，已盡力防止侵害著作權人之權益，如仍發現本網站之數位內容有侵害著作權人權益情事者，請權利人通知本網站維護人員(nccur@nccu.edu.tw)，維護人員將立即採取移除該數位著作等補救措施。
    NCCU Institutional Repository is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff(nccur@nccu.edu.tw). We will remove the work from the repository and investigate your claim.
    DSpace Software Copyright © 2002-2004  MIT &  Hewlett-Packard  /   Enhanced by   NTU Library IR team Copyright ©   - 回馈