*中心館藏網址:http://tulips.ntu.edu.tw/record=b2222451*cht

[ 摘要 ]
摘要 疼痛對病人來說是非常主觀的感受，對每個人的意義也不同。到目前為止，許多研究針對心理、社會因素如文化價值觀、宗教信仰等已確知對個人疼痛感受有所影響，導致每個人對於疼痛的忍受度及表現上有明顯的差異。因此，本研究依據醫療人類學獨特的理論及應用層面，深入探討花蓮市某大型區域教學醫院外科病房之不同族群（漢人、泰雅及阿美等族）病患疼痛經驗與社會文化相關性意含，藉由個人疼痛感受及疼痛表現行為來瞭解其背後所涉及的病痛及連帶的身體、自我及社會文化意義。 本研究資料收集變項包含：基本社會人口學特性如性別、社經地位、社會支持/社會網絡、超自然/宗教信仰等；及文化背景包括族別、價值觀、文化信念等。運用參與觀察及深入訪談等方式，以深入探討各變項影響下各族群不同的疼痛經驗。本研究共計訪問21位患者，其中漢族八位，阿美族七位及泰雅族六位。 研究結果發現：一、三個族群具有不同的疼痛態度，影響各族群對止痛藥的使用及醫病關係上。漢族患者疼痛態度傾向於未來取向，也就是重視病情的解釋及預後的發展。泰雅族患者傾向於現在取向，也就是期望疼痛獲得立即的緩解。因此，疼痛的態度也相同的反應在族群對於止痛藥的認知及態度方面，泰雅族患者普遍能以正向的態度接受止痛藥的施打；漢族患者對於止痛藥存有較多的負面的思考，如成癮、依賴及傷身等。並容易有私藏藥物的行為出現。二、疼痛反應行為部份，阿美族患者認為哭泣，求救是一種情緒宣洩的管道，對疼痛有幫助；而漢族以理性忍耐的方式來博取醫護人員的認同進而達到解釋病情的目的。但泰雅族傳統以來強調個人英勇式的行為。因此，會常以忍耐及壓抑疼痛的感受。三、族群內部社會人口學變項，如：社經地位、性別、宗教信仰等，也相同的會影響患者的疼痛經驗。因此，三個不同文化族群即使有相似的疼痛反應，如壓抑及忍耐等，卻表現出不同的疼痛態度；族群間反應疼痛的行為相似，卻有不同的功能及目的。 研究結果期望能提供臨床醫護人員在疼痛問題的探討上，運用文化主位的觀點深入瞭解疼痛者的主觀感受，並站在『人本』為關懷的立場，增加患者之『安適感』。

[ 英文摘要 ]
Pain is a subjective sensation affected by many variables. Culture has been identified as a factor that influences a person’s reaction to and expression of pain. Although pain is held to be basically a physiological phenomenon and as such has been studied by physiologists and neurologists. Culture is an important variable in determining an individual’s pain experience. The study encompasses two parts： quantitative and qualitative research . The patient samples were gathered from the inpatient of orthopedics department of Mennonite General Hospital. Among 21 interviewees, 6 were Atayal, 7 were Amis and 8 were Han Chinese. The interviews, based a series of open-ended questions, were focussed upon pain experience of interviewee. With regard to the pathological causes of pain majority of the interviewees fall into the group of patients suffering from acute fracture pain. The results showed （1）Attitude and cognition of Atayal, Amis and Han Chinese patients toward pain-relieving drugs, the doctor-patient relationship can serve as an indication of their attitude toward pain. The different between the Atayal and Han Chinese attitudes of pain, the Atayal patients tends to manifest a present-oriented to the actual sensation pain. The Han Chinese patients is characterized by a future-oriented to it.（2）Culture and social conditioning played an important role in pain behavior. The Amis patients tend to reactions to pain and their culture allow for free expression of feeling and emotion by words, sounds and gestures. The Han Chinese patient attempts to minimize pain, tendency to stoicism and calm. The Atayal patient usually demonstrates few emotional side reactions to pain, tendency to heroism and calm.（3）The socio-economic background, education, social support network and religiosity may play an important role. Discussion：Similar reactive to pain manifested by members of different ethno-cultural groups do not necessarily reflect similar attitude to pain.