慢性病患失能初期評價性自我概念之變化：以腎病末期患者為例

The Change of Evaluative Self-concept in Chronic Disabled Patients at Early Sick Stage: In the Case of End-stage Renal Disease Patients

本研究關心嚴重生理功能損傷之失能性疾病（如失去重要器官或肢體殘障）患者，在失能初期驟然面對殘障的心理調適歷程。主要目的在探討患者評價性自我概念之歷時性變化，以做為臨床實務工作中提昇患者自尊感之參考。本研究將罹患腎病末期，年齡在55歲以下，接受透析治療兩年內之患者納入篩選對象，共訪談82 位患者。由有多年臨床經驗之臨床心理師以結構式問卷進行訪談，內容包括病患角色認定調查表與下述變項之測量：失能前及現在之整體性自尊感高低；針對人生意義、健康狀況、活動與生涯限制、能力與才幹、社會功能與地位、家人之支持、回報能力、家庭功能等八個自我向度，在失能前、剛發病時、現在、及預期未來之自我評價的相對變化；上述八個自我評價向度在失能前、剛發病時、及現在之心理權重性相對變化。先以病患角色認定調查表，篩選17名處於抗拒階段與36名接受階段患者進行比較分析。結果顯示，兩組受試者目前之整體性自尊感得分相較於失能前皆明顯降低。在自我評價方面，接受組受試者在受訪當時，主觀上對自我的評價明顯低於失能前，同時也預期未來無法恢復到失能前的狀態。抗拒組受試者在受訪當時，主觀上認為自己的狀況比起失能前稍差但無顯著差異，同時預期未來可恢復到失能前的狀態。在心理權重性方面，接受組患者體認到失能後大部份自我向度都變得不再那麼重要，唯有「健康狀況」與「家人之態度」才是最重要的。而抗拒組受試者，即使患病時間與接受組受試者相當，但並未調整各個自我向度之心理權重性。可見，影響失能初期患者之自我尊嚴的自我評價與心理權重性皆受到其社會認定所影響。

The study chooses end-stage renal disease patient samples less than 55 years old who had dialysis cure within two years. We have 82 interviewees. Experienced clinical psychologists use a structured questionnaire to conduct interviews. The contents of the questionnaire include “patient role identification scale” and the relative change of selfevaluation and psychological centrality of eight self domains. We use “patients role identification scale” to select 17 resistance and 36 acceptance stage patients for comparison analysis. The result indicates that present global self-esteem of the two groups compare with that of before the disease has a significant decrease. In the self-evaluation relative change scale, the acceptance stage patients drop the scale dramatically when disease onset and come back slowly but not the level as before. The resistance stage patients evaluate themselves as no significant differences than before and expect they can get well as before. In psychological centrality relative change scale, the acceptance stage patients realize that nothing is so important except “health status” and “supports from family”. Even though the resistance stage patients have the same duration of disease they still can’t adjust their psychological centrality of self domains as those patients in acceptance stage. The results indicate that the differences of self- evaluation and psychological centrality between two groups are due to social identity of patients.