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題名 優勢觀點團體運用於緩解社區獨居長者孤獨感之成效研究
The Effective of Strengths-Based Group Intervention to Elderly People Living Alone in the Community with Loneliness作者 李玉芬
LI, Yu-Fen貢獻者 宋麗玉
Song, Li-Yu
李玉芬
LI, Yu-Fen關鍵詞 優勢觀點團體處遇
社區獨居長者
孤獨感
成效
Strength-Based Group Intervention
elderly people living alone in the community
loneliness
effectiveness日期 2021 上傳時間 1-七月-2021 20:37:39 (UTC+8) 摘要 摘要 在人口老齡化的背景下，受家庭子女數減少、居住條件與居住觀念變化，以及人口跨地域快速流動等因素的影響，獨居已經成為大陸長者的主流居住模式。隨著獨居長者數量的日趨增長，其「孤獨感」已逐漸成為值得大家關注的社會問題。孤獨感是由某種形式的社會關係缺失，引起的令人不愉快的甚至痛苦的主觀體驗。受居住方式的限制，以及社會、文化、制度與科技等因素的影響，中國的社區獨居長者與一般長者或西方國家的獨居長者相比經歷孤獨感的風險更高。作為一種負向的情緒體驗，孤獨感會對長者的身心健康造成不利的影響，嚴重損害了社區獨居長者的健康與福祉。 目前關於長者孤獨感的干預研究以西方國家為主流，從社會關係需求、行為與人格特質、認知以及懷舊四個視角出發，依循傳統醫療取向的工作典範，分別探討相對應的干預模式。既有的干預實踐忽略了長者自身擁有的優勢與資源，對長者心理、社會與精神健康亦缺乏全方位的關注。1980年代發展自美國堪薩斯大學社會工作學院的優勢觀點，正是對社會工作實務偏向醫療模式和問題解決取向的一種反思。本研究將優勢觀點的理念、原則和方法運用於我國社區獨居長者孤獨感之干預研究，探索融入「生命歷程」視角的優勢觀點團體對於緩解社區獨居長者孤獨感的成效。 研究採用質量並行的混合研究方法，量化部分採用古典實驗設計，將根據標準選取的26位研究對象隨機分配至實驗組和控制組，實驗組接受14次優勢觀點團體處遇，採用UCLA孤獨感量表（第三版中文版）、增強權能量表和LSI-A生活满意度指数A量表（中文版），在處遇前、中（團體7次），後（團體14次）為實驗組和控制組的研究對象進行測量。除此之外，通過優勢觀點團體過程紀錄和團體結束後的深度訪談，檢驗、補充和拓展量化研究的結果。經整理，本研究的發現與結論如下： 1、「優勢觀點團體」處遇通過促進團體成員有意義的社會參與、改善團體成員的社會關係狀況和轉變團體成員的思維方式，可達到緩解社區獨居長者孤獨感狀況、改善其權能感狀況及生活滿意度狀況的處遇目標，初步證實了「優勢觀點團體」處遇的成效； 2、融入「生命歷程」視角之「優勢觀點團體」處遇對於緩解大陸社區獨居長者孤獨感之適用性與經驗： （1）「生命歷程」視角之「優勢觀點團體」具有適用性，探索和運用團體成員優勢的過程，亦是發現和激發個體能動性的過程；融入「生命歷程」視角的優勢探索歷程與大陸長者「話當年」的內容與目標相似，未來可將「話當年」的元素和表達方式更多地融入「生命歷程」視角下的優勢探索歷程，提升其對本土文化的適應性，改善處遇效果； （2）在以「責任倫理」為核心的中國養老文化背景下，運用優勢觀點團體處遇於緩解大陸社區獨居長者孤獨感時，需要積極適應我國的養老文化，重視獨居長者對於子代親密關係的需求； （3）「優勢觀點」視角下開展的老年服務重視挖掘和運用長者的優勢和想望，有助於長者狀況的改善，符合大陸長者對於老年服務的需要，未來可將「優勢觀點」更多地運用於大陸的長者服務。
Abstract In the context of an aging population, affected by factors such as the reduction in number of children in the family, changes in living conditions and living idea, and rapid population flow across regions, living alone has become the mainstream residential mode for mainland elders. With the increasing number of elderly people living alone, their "loneliness" has gradually become a social issue worthy of everyone`s attention. Loneliness is an unpleasant and even painful subjective experience caused by some form of lack of social relations. Be affected with the living style，social, cultural, institutional and technological factors, elderly people living alone in the Chinese community are at higher risk of experiencing loneliness than the other elderly or those living alone in Western countries. As a negative emotional experience, loneliness will adversely affect the physical and mental health of the elderly, and seriously damage the health and well-being of the elderly living alone in the community. The current intervention research on the loneliness of the elderly starting from the four theoretical perspectives of social relationship needs, behavior and personality traits, cognition and reminiscence, and following the traditional medical orientation work model, respectively exploring the corresponding treatment models. Existing practices ignore the strengths and resources that the elders have, and they pay little attention to the psychological, social and mental health of the elders. The strengths perspective focus on people’s strengths and resources, developed in United Stated for more than 40 years. This study applies the ideas, principles and methods of the strength perspective to the intervention research on the elders living alone in community with loneliness, and explores the effectiveness of the Strength-Based Group in alleviating the loneliness of the elders living alone in the community. This study combined both qualitative and quantitative research methods. The quantitative part adopts classical experimental research. The 26 research subjects selected according to the standard are randomly assigned to the experimental group and the control group，the experimental group accepted 14 times group intervention. Participants in all conditions completed evaluation measures before, during and after the intervention. In addition, the qualitative research tested, supplemented and expanded the results of the quantitative research. The conclusions are as follows: 1. Strength-Based Group intervention can promote meaningful social participation，improve social relations, and bring about changes in thinking patterns, thereby alleviating group members’ loneliness，improving group members’ sense of power and life satisfaction. The results have been confirmed the effectiveness of Strength-Based Group intervention. 2. The applicability and experiences of the Strength-Based Group intervention applied to alleviate the loneliness of elderly people living alone in mainland communities may be listed in the following three points. (1) The strengths exploration process with "life course" perspective is similar to "Talking about Old times" which mainland elders always do. In the future, the elements and expressions of " Talking about Old times " can be more apply to the strength exploration process, so as to enhance its adaptability to the local culture. (2) In the context of Chinese culture with "responsibility ethics" as the core，inspires that when the Strength-Based Group intervention applied to alleviate the loneliness of the elderly living alone in mainland communities, it is necessary to actively adapt to Chinese culture. (3) The Strength-Based services for the elderly aims at explore and utilize the strengths and aspirations of the elderly, which can promote the "meaningful social participation"，improve conditions, and meets the needs of the elderly in mainland China. 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國立政治大學
社會工作研究所
106264503資料來源 http://thesis.lib.nccu.edu.tw/record/#G0106264503 資料類型 thesis dc.contributor.advisor 宋麗玉 zh_TW dc.contributor.advisor Song, Li-Yu en_US dc.contributor.author (Authors) 李玉芬 zh_TW dc.contributor.author (Authors) LI, Yu-Fen en_US dc.creator (作者) 李玉芬 zh_TW dc.creator (作者) LI, Yu-Fen en_US dc.date (日期) 2021 en_US dc.date.accessioned 1-七月-2021 20:37:39 (UTC+8) - dc.date.available 1-七月-2021 20:37:39 (UTC+8) - dc.date.issued (上傳時間) 1-七月-2021 20:37:39 (UTC+8) - dc.identifier (Other Identifiers) G0106264503 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/135999 - dc.description (描述) 博士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 社會工作研究所 zh_TW dc.description (描述) 106264503 zh_TW dc.description.abstract (摘要) 摘要 在人口老齡化的背景下，受家庭子女數減少、居住條件與居住觀念變化，以及人口跨地域快速流動等因素的影響，獨居已經成為大陸長者的主流居住模式。隨著獨居長者數量的日趨增長，其「孤獨感」已逐漸成為值得大家關注的社會問題。孤獨感是由某種形式的社會關係缺失，引起的令人不愉快的甚至痛苦的主觀體驗。受居住方式的限制，以及社會、文化、制度與科技等因素的影響，中國的社區獨居長者與一般長者或西方國家的獨居長者相比經歷孤獨感的風險更高。作為一種負向的情緒體驗，孤獨感會對長者的身心健康造成不利的影響，嚴重損害了社區獨居長者的健康與福祉。 目前關於長者孤獨感的干預研究以西方國家為主流，從社會關係需求、行為與人格特質、認知以及懷舊四個視角出發，依循傳統醫療取向的工作典範，分別探討相對應的干預模式。既有的干預實踐忽略了長者自身擁有的優勢與資源，對長者心理、社會與精神健康亦缺乏全方位的關注。1980年代發展自美國堪薩斯大學社會工作學院的優勢觀點，正是對社會工作實務偏向醫療模式和問題解決取向的一種反思。本研究將優勢觀點的理念、原則和方法運用於我國社區獨居長者孤獨感之干預研究，探索融入「生命歷程」視角的優勢觀點團體對於緩解社區獨居長者孤獨感的成效。 研究採用質量並行的混合研究方法，量化部分採用古典實驗設計，將根據標準選取的26位研究對象隨機分配至實驗組和控制組，實驗組接受14次優勢觀點團體處遇，採用UCLA孤獨感量表（第三版中文版）、增強權能量表和LSI-A生活满意度指数A量表（中文版），在處遇前、中（團體7次），後（團體14次）為實驗組和控制組的研究對象進行測量。除此之外，通過優勢觀點團體過程紀錄和團體結束後的深度訪談，檢驗、補充和拓展量化研究的結果。經整理，本研究的發現與結論如下： 1、「優勢觀點團體」處遇通過促進團體成員有意義的社會參與、改善團體成員的社會關係狀況和轉變團體成員的思維方式，可達到緩解社區獨居長者孤獨感狀況、改善其權能感狀況及生活滿意度狀況的處遇目標，初步證實了「優勢觀點團體」處遇的成效； 2、融入「生命歷程」視角之「優勢觀點團體」處遇對於緩解大陸社區獨居長者孤獨感之適用性與經驗： （1）「生命歷程」視角之「優勢觀點團體」具有適用性，探索和運用團體成員優勢的過程，亦是發現和激發個體能動性的過程；融入「生命歷程」視角的優勢探索歷程與大陸長者「話當年」的內容與目標相似，未來可將「話當年」的元素和表達方式更多地融入「生命歷程」視角下的優勢探索歷程，提升其對本土文化的適應性，改善處遇效果； （2）在以「責任倫理」為核心的中國養老文化背景下，運用優勢觀點團體處遇於緩解大陸社區獨居長者孤獨感時，需要積極適應我國的養老文化，重視獨居長者對於子代親密關係的需求； （3）「優勢觀點」視角下開展的老年服務重視挖掘和運用長者的優勢和想望，有助於長者狀況的改善，符合大陸長者對於老年服務的需要，未來可將「優勢觀點」更多地運用於大陸的長者服務。 zh_TW dc.description.abstract (摘要) Abstract In the context of an aging population, affected by factors such as the reduction in number of children in the family, changes in living conditions and living idea, and rapid population flow across regions, living alone has become the mainstream residential mode for mainland elders. With the increasing number of elderly people living alone, their "loneliness" has gradually become a social issue worthy of everyone`s attention. Loneliness is an unpleasant and even painful subjective experience caused by some form of lack of social relations. Be affected with the living style，social, cultural, institutional and technological factors, elderly people living alone in the Chinese community are at higher risk of experiencing loneliness than the other elderly or those living alone in Western countries. As a negative emotional experience, loneliness will adversely affect the physical and mental health of the elderly, and seriously damage the health and well-being of the elderly living alone in the community. The current intervention research on the loneliness of the elderly starting from the four theoretical perspectives of social relationship needs, behavior and personality traits, cognition and reminiscence, and following the traditional medical orientation work model, respectively exploring the corresponding treatment models. Existing practices ignore the strengths and resources that the elders have, and they pay little attention to the psychological, social and mental health of the elders. The strengths perspective focus on people’s strengths and resources, developed in United Stated for more than 40 years. This study applies the ideas, principles and methods of the strength perspective to the intervention research on the elders living alone in community with loneliness, and explores the effectiveness of the Strength-Based Group in alleviating the loneliness of the elders living alone in the community. This study combined both qualitative and quantitative research methods. The quantitative part adopts classical experimental research. The 26 research subjects selected according to the standard are randomly assigned to the experimental group and the control group，the experimental group accepted 14 times group intervention. Participants in all conditions completed evaluation measures before, during and after the intervention. In addition, the qualitative research tested, supplemented and expanded the results of the quantitative research. The conclusions are as follows: 1. Strength-Based Group intervention can promote meaningful social participation，improve social relations, and bring about changes in thinking patterns, thereby alleviating group members’ loneliness，improving group members’ sense of power and life satisfaction. The results have been confirmed the effectiveness of Strength-Based Group intervention. 2. The applicability and experiences of the Strength-Based Group intervention applied to alleviate the loneliness of elderly people living alone in mainland communities may be listed in the following three points. (1) The strengths exploration process with "life course" perspective is similar to "Talking about Old times" which mainland elders always do. In the future, the elements and expressions of " Talking about Old times " can be more apply to the strength exploration process, so as to enhance its adaptability to the local culture. (2) In the context of Chinese culture with "responsibility ethics" as the core，inspires that when the Strength-Based Group intervention applied to alleviate the loneliness of the elderly living alone in mainland communities, it is necessary to actively adapt to Chinese culture. (3) The Strength-Based services for the elderly aims at explore and utilize the strengths and aspirations of the elderly, which can promote the "meaningful social participation"，improve conditions, and meets the needs of the elderly in mainland China. In the future, the " Strength Perspective " can be applied more to the elderly services in mainland China. en_US dc.description.tableofcontents 目錄 第一章 緒論 1 第一節 研究背景與目的 1 壹、研究的現實背景 1 貳、研究的理論背景 3 第二節 研究目的 6 第二章 文獻探討 9 獨居長者及其孤獨感狀況文獻探討 9 第一節 獨居長者 9 壹、獨居長者的概念、數量與產生背景 9 貳、獨居對長者的影響 12 第二節 中國社區獨居長者的孤獨感狀況 14 壹、中國社區獨居長者的孤獨感狀況 14 貳、影響中國社區獨居長者孤獨感的因素 14 叄、孤獨感对长者的負面影響 16 孤獨感相關文獻探討 17 第三節 孤獨感的概念內涵及相關理論 17 壹、孤獨感的概念內涵 17 貳、孤獨感的相關理論 21 第四節 孤獨感的分類與測量 23 壹、孤獨感的分類 23 貳、孤獨感的測量 24 第五節 長者孤獨感的影響因素 25 壹、人口特徵 25 貳、健康狀況 27 叁、獨居意願 27 肆、社會關係 28 第六節 長者孤獨感的干預 29 壹、社會關係需求視角 29 貳、行為／人格特質與認知視角 30 叁、懷舊視角 31 第七節 孤獨感文獻探討小結 32 壹、長者孤獨感研究的總結 32 貳、本文研究的基礎、可借鑑的經驗及研究的起點 33 優勢觀點相關文獻探討 34 第八節 優勢觀點下長者社會工作的理論內涵 35 壹、優勢觀點下長者領域社會工作的基本理念 35 貳、優勢觀點下長者領域社會工作的原則 37 叁、優勢觀點下長者領域社會工作的處遇架構 39 第九節 優勢觀點下長者社會工作的實務研究與運用 43 壹、優勢觀點在長者優勢評量方面的實務研究 43 貳、優勢觀點在長者照顧方面的實務研究 47 叁、優勢觀點在長者心理與精神健康方面的實務研究 49 第十節 優勢觀點團體之運用狀況 52 第十一節 優勢觀點文獻探討小結 57 壹、優勢觀點理論與實務研究總結 57 貳、本文研究的理論基礎、可借鑑的經驗及可拓展的空間 58 第三章 研究方法 61 第一節 研究方法 61 第二節 研究設計與假設 63 壹、量化研究設計 63 貳、量化研究假設 64 第三節 研究對象 65 壹、研究場域 65 貳、研究參與者 67 第四節 優勢觀點團體方案 68 壹、優勢觀點團體方案設計 68 貳、優勢觀點團體方案內容 70 第五節 資料蒐集 79 壹、量化資料蒐集方式 79 貳、質化資料蒐集方式 82 叄、答謝方式 83 第六節 資料分析 83 壹、量化資料分析方式 84 貳、質化資料分析方式 84 第七節 研究倫理 86 壹、非傷害性原則 86 貳、保護性原則 86 叄、知情原則與自願原則 87 肆、尊重隱私與保密性原則 87 伍、研究成果分享原則 87 陸、研究者身份 88 第八節 研究預期困難及應對方法 88 壹、疫情對此次研究的影響 88 貳、研究參與者中途退出 89 叄、研究對象錯誤填答問卷 89 第九節 研究實施階段及時程安排 90 壹、第一階段：規劃階段 90 貳、第二階段：團體處遇階段 90 叄、第三階段：論文寫作階段 91 第四章 優勢觀點團體歷程分析 93 第一節 團體成員簡介及團體概況 93 第二節形成期（FORMING）：優勢觀點團體啟程 104 壹、團體歷程記錄 104 貳、團體歷程分析 107 第三節 激盪期（STORMING）：生命歷程回顧與優勢探索 108 壹、團體歷程記錄 108 貳、團體歷程分析 110 第四節 規範期（NORMING）：生命歷程總結與優勢評量 112 壹、團體歷程記錄 112 貳、團體歷程分析 121 第五節 表現期（PERFORMING）：未來生命歷程規劃-建立優勢為導向的生活計畫 123 壹、團體歷程記錄 123 貳、團體歷程分析 129 第六節 結束期（ADJOURNING）：優勢觀點團體結束 131 壹、團體歷程記錄 131 貳、團體歷程分析 136 第七節 優勢觀點原則的運用與影響 138 壹、原則一：每個人都有學習、成長與改變的能力 140 貳、原則二：工作的焦點在優點而非病理 143 叄、原则三：案主是助人關係的指導者 147 肆、原则四：關係的建立是基本且重要的 148 伍、原則五：外展是較佳的處遇方式 150 陸、原則六：社區是資源的綠洲 151 第五章 量化分析 153 第一節 研究對象基本狀況 153 壹、研究對象背景資料 153 貳、研究對象依變項前測資料 155 第二節 優勢觀點團體處遇對孤獨感影響 155 壹、描述性統計 155 貳、成效分析 156 第三節 優勢觀點團體處遇對增強權能影響 159 壹、描述性统计 159 貳、成效分析 161 第四節 優勢觀點團體對生活滿意度影響 182 壹、描述性統計 182 貳、成效分析 183 第五節 總結與分析 185 壹、研究發現支持優勢觀點團體之成效 185 貳、優勢觀點團體後期處遇成效更為明顯 186 叄、優勢觀點團體可激發獨居長者社區參與的熱情 187 肆、團體成員的狀況仍有待改善 187 第六章 質化分析 189 第一節 孤獨感之改變狀況 189 壹、孤獨感 190 貳、身心健康 191 第二節 增強權能與生活滿意度之改變狀況 192 壹、增強權能 193 貳、生活滿意度 194 第三節 優勢觀點團體處遇促進有意義的社會參與 195 壹、改變因素：有意義的社會參與，重構老年生活價值 195 貳、改變方法：優勢评量与個人工作计划，促進有意義的社會參與 199 第四節 優勢觀點團體處遇促成社會關係的改善 201 壹、改變因素：社會關係狀況改善，緩解長者孤獨感 202 貳、改變方法：優勢取向的互助團體氛圍與互動體驗，促成人際關係的改善 204 第五節 優勢觀點團體處遇帶來思維方式的轉變 206 壹、改變因素：思維方式的轉變，積極面對老年生活 206 貳、改變方法：引導和協助成員形成優勢取向的思維方式 207 第六節 本章小結 208 第七章 討論與建議 211 第一節 研究討論 211 壹、「生命歷程」視角下「優勢觀點團體」處遇的適應性議題 212 貳、以「責任倫理」為核心的中國養老文化對優勢觀點團體處遇的影響議題 215 叄、「優勢觀點」與「本土養老服務」的契合性議題 218 第二節 研究貢獻、限制及建議 219 壹、研究貢獻 219 貳、研究限制與建議 220 第三節 結語 223 參考文獻 225 一、中文部分 225 二、英文部分 229 附錄一 241 一、研究對象背景資料的結構式問卷 241 二、UCLA第三版孤獨感量表（中文版） 241 三、增強權能量表 243 四、生活滿意度指數A量表（LIFE SATISFACTION INDEX A，LSIA） 245 附錄二 247 質性訪談大綱 247 附錄三 248 參與研究同意書（實驗組成員） 248 參與研究同意書（控制組成員） 249 zh_TW dc.source.uri (資料來源) 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