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

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

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。

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.