台灣東部不同族群間疼痛經驗與文化意涵之研究

The Cultural Meanings of Pain Experience among Three Ethnic Groups in Eastern of Taiwan

研究目的：本研究為探討台灣東部三個原漢族群疼痛經驗下之文化意涵，並釐清族群間疼痛經驗的差異性。研究方法：本研究採用民族誌研究法，研究場域為東部某教學醫院急性骨外科病房，共訪問21位急性骨折患者，分別是阿美族7位、泰雅族6位及漢族8位。資料收集採用個別深度訪談與參與觀察，以內容分析法進行資料分析。研究結果：將研究主題區分為疼痛反應方式、疼痛信念及止痛藥使用信念。發現在疼痛反應方式上，泰雅族傾向於壓抑情緒表露，阿美族為直接情緒表露，而漢族則呈現理性情緒表露。在疼痛信念部分，漢族傾向於擔心疾病預後的理性／知識取向，而泰雅族則期望疼痛能立即獲得緩解的情感取向。止痛藥的使用信念部分，漢族傾向負向信念，而普遍泰雅族則對止痛藥的使用有正向信念。研究結論：本研究希望臨床醫護人員在疼痛問題的處理上，應凸顯泛文化主位觀點照護的重要性，重視族群的差異性，才能釐清疼痛問題的本質，增加患者的身心安適感。

Purpose: The purpose of this study was to describe cultural meanings related to the pain experience among three Han and Aboriginal groups in Taiwan. Methods: Ethnography was the methodology used in this study. Twenty-one patients with acute fracture pain (6 from the Atayal Aboriginal group, 7 from the Amis Aboriginal group, and 8 Han Chinese) were selected from the orthopedic units of a teaching hospital in eastern Taiwan. Data collected consisted of patient information, participant observations and in-depth interviews based on a series of open-ended questions, which focused on the interviewee’s pain experience. Content analysis was used in the study. Results: The results demonstrated three themes, pain expression, pain beliefs, and opioid analgesic-utilized beliefs. Suppressed expression towards pain was characteristic of the pain reactions of the Atayal. The pain reactions of the Amis tended to be directly expressed emotions. In the Hans, pain reactions tend to be rational expressed emotions. The pain belief of the Hans is a rational/ knowledgeable orientation towards disease prognosis. However, the Atayal expected pain relief immediately, and the pain belief tended to affective orientation. The difference in patients’ pain beliefs among the three ethnic groups will inevitably influence physician-patient relationships as well as opioid analgesic-utilized beliefs. In the Hans, a negative belief towards opioid analgesics tended to decrease willingness to use these drugs. However, the opioid analgesic belief of the Atayal was positive. A positive opioid analgesic belief tended to increase willingness to relay on medicine to relieve pain. Conclusions: This study suggests that if clinicians and nurses take the emic perspective of cross-cultural comparative results when dealing with the problem of pain, as well as perceive the variety of patient’s suffering and pain, they can understand the nature of the problem of pain so as to increase the patient’s well-being.