失志的概念分析

Demoralization: A Concept Analysis

失志（demoralization）是近年來備受關注的新診斷，最常發生在安寧、癌症及重症病人身上，嚴重者會有自殺之意圖。目前國內外對於失志雖有文獻探討，但大多為歷史的闡述及量表發展之信效度檢測，並無系統性的概念分析。本文依據Walker及Avant之概念分析步驟，進行失志的概念分析，藉此闡述其定義特徵及屬性，並列舉典型案例、邊緣案例、相關案例、相反案例，以釐清其概念，進而確認失志發生之前置因子與後果，並檢視相關實證資料。期望藉此概念分析，增加臨床照護者對失志的了解，提供評估失志的知識與方法，積極幫助病人走出失志的陰霾。

Demoralization is a relatively new diagnosis that has received increased attention in recent years. This condition is most frequently diagnosed in hospice, cancer, and critical illness patients. Serious demoralization may induce suicide ideation. The current literature on demoralization primarily elaborates on the history of this condition and on the reliability / validation of scales developed to assess demoralization in patients. The present paper conducts a concept analysis of demoralization in accordance with the concept analysis steps outlined by Walker and Avant. We elucidate the definition of relevant terms and identify the characteristic attributes, antecedents, and consequences of demoralization. Additionally, this paper provides examples of model, borderline, contrary, relevant cases and reviews relevant empirical data. We hope this concept analysis enhances the understanding of demoralization among clinical caregivers, increases the general understanding of the methods available to assess demoralization, and, ultimately, helps set patients free of their demoralization haze.