後天免疫缺乏症候群患者之自主信念

Beliefs of self－determination in AIDS Patients

雖然後天免疫缺乏症候群(AIDS)患者在疾病歷程中不斷的面對因疾病而引發的多重挑戰，然而疾病歷程同時亦提供患者發掘意義及個人生命強韌性的機會，本文之研究者曾針對國內14位患者進行其疾病經驗之現象學研究，發現絕大多數的患者在面對疾病及死亡的威脅的同時，仍篤定的抱持著自主及自決的心情選擇積極的活著，其中有四位患者特別表現出高度的自主及自決，本研究目的在於呈現此四位患者所抱持的三項關鍵性信念，此本土性研究期魴提高醫療人員對患者在疾病因應中自主及自決之了解，進而在醫病互動的過程中鼓勵患者培養並發揮自主及自決的精神。研究者收集資料的方式乃以開放性問題進行深度訪談，每個訪談的內容均以記錄音帶記錄，而後膳寫成文字稿以確保資料之完整性，並以開放性譯碼的方式分析資料；本研究的四位男性患者，其平均年齡為36歲，而其得知自己為HIV陽性反應的期間平均為25.75個月，研究結果顯示患者高度自主及自決精神三項關 鍵性信念為「定位在要活下去」、「迎向挑戰並堅持往前」、「選擇快樂而非愁苦過活；本研究結果可以做為醫療人員鼓勵患者培養並發揮自主及自決精神的基礎，醫療人員更可針對患者在不同疾病階段的需要設計系統性的措施，以促進自主及自決的精神並提昇因應及調適之能力。

In the current psychosocial literature on human immunodeficiency virus(HIV), emphasis has been placed on the traumatic impact of acquired immunodeficiency syndrome (AIDS)and multiple stressors associated with HIV infection. However, it is necessary and desirable to balance this with a look at patients' personal strengths in effective coping. Of the 14 HIV/AIDS patients in Taiwan who participated in a phenomenological study regarding their preservation strategies, four were remarkable in having a high level of self-determination. The purpose of this study was to investigate the core beliefs of patients will aid healthcare professionals in designing appropriate interventions to educate patients for adaptive success. In-depth, open-ended interviews were used to collect data. Interviews were tape-recorded and transcribed verbatim to maintain data integrity and to reduce perceptual bias. The open coding procedure was used to analyze the interview transcripts. Study participants were four male patients with an average age of 36 years, who had known their positive HIV status for an average of 25.75 months. The three core beliefs that typified these men's high level of self-determination were focus on living, meeting challenges and persistently moving forward, and choosing to be happy instead of miserable. The findings of this study form the basis for healthcare professionals to design services aimed at facilitating a high level of self-determination during illness. Further efforts could focus on developing systemic intervention programs to help patients better cope with the challenges of living with HIV/AIDS.