失智症患者因認知障礙及行為問題使得照護人員常面臨複雜之溝通情境，而長期照護機構之護理人員為與失智症患者溝通的主要對象，因此深入了解護理人員面臨的溝通困難及其對促進有效溝通的需求，以提供護理人員之失智症溝通教育之實證參考。護理人員若能接受專業溝通教育訓練，可提升與失智症患者溝通之敏感度，且能更了解患者的照護需求，進而改善照護品質。截至目前為止，在台灣關於失智症患者溝通之相關研究及論述仍較著重於教導護理人員與失智症患者溝通技巧，而忽略探究護理人員本身與失智症患者之溝通困難。本研究目的在探討護理人員與失智症患者溝通時所遭遇之困難、了解阻礙溝通的因素、並探知護理人員的需求。研究設計為探索性質性研究。運用深度訪談法，以立意取樣的方式，從南部數所長期照護機構中取得實際照顧失智症患者經驗之護理人員為研究對象，以內容分析法做資料分析，研究結果分三個範疇呈現八個主題:（一）溝通困難為雞同鴨講及難入內心；（二）阻礙溝通的因素為機構環境之限制、自我準備度不足、先入為主之觀感；（三）溝通的需求為經驗累積及同儕分享、知識再造與心靈成長、機構及外界之協助。研究推論因長期照護機構聚焦身體照護，使得護理人員無足夠時間而處於溝通困境之中，再加上護理人員本身對失智症溝通的經驗及學習有限，致遭遇溝通困難時，易產生退縮及迴避的反應而影響傾聽及回饋，因而降低可協助失智症患者獲得身心安適之溝通品質。期望本研究結果能提供未來護理教育與護理實務在規劃失智溝通相關教育計畫之實證參考。而長期照護機構能加強人力資源分配及補給、提供護理人員心靈成長及溝通問題的諮詢對象、改善溝通環境之硬體設置等，皆為提升護理人員與失智症患者溝通之要務。

Because of patients’ language defect and behavioral problems, caregivers often face complexes when communicating with dementia patients. Nurses in long-term care facilities play a key role to communicate with dementia elders. Therefore, understanding nurses’ difficulties and demands in communicating with dementia patients become critical. If nurses could receive professional training in communication, their sensitivity to patients needs will increase, and so the quality of care may improve. Past dementia communication researches were mainly focused on intervention skill development; very few explored communication difficulties among nurses. Therefore, the purpose of this study was to explore nurses’ predicaments and demands in communication with dementia patient. Besides, factors affecting communication were examined. Exploratory qualitative research design using in-depth interview and purposive sampling were applied. Study subjects are nurses who have care experience in dementia elderly from several long-term care institutions in southern Taiwan. Data were analyzed using content analysis. Eight themes direct to communication difficulties, factors affecting communication, and future need were emerged respectively:(1) Difficulty in irrelevant communication and difficulty in approaching patient’s world;(2) Factors affecting with environmental limitation, self-preparation insufficiency, and prejudice;(3) Need of experience gain and peer sharing, knowledge restoration and spiritual growth, and assistance from institution and outside condition. Discussion of this study implies that physical care oriented environment in long-term care institutions impedes nurses’ effective communication with dementia patients which decrease well-being and care quality received among this population. Findings can be the basis when planning for future nursing curriculum and practice. Furthermore, increasing human resource allocation and replenishment, providing spiritual care and consultation services, improving environmental space and equipment are important tasks for effective communication between nurses and patients.

內政部統計處（2009）．國際統計指標：老年人口、老化指數．2009
年8月8日取自http://www.moi.gov.tw/stat/index.asp
內政部統計處（2009）．身心障礙者人數統計．2009年7月1日取
自http://www.moi.gov.tw/stat/index.asp
台灣失智症協會（2006）．失智症盛行率調查報告．2008年10月8日取自http://www.tds.org.tw/html/front/bin/ptlist.phtml?Category=121256
台南市熱蘭遮失智症協會（2006）．失智症介紹．2008年10月8日取
自http://zda.mytw.net/
失智症網上資源中心（2009）．溝通技巧．2009年10月3日取自
http://www.ginkgogroup.org/?action-viewnews-itemid-39
毛新春（2002）．醫護人員與癌末病患溝通之藝術．台灣醫學，6（3），430-436。
多湖輝（2001）．透視人性弱點．台北:大展。
李宗派（2005）．溝通技巧：如何與老人失智症者保持和諧之關係．台灣老人保
健學刊，1（2），1-14。
李宗派（2005）．失智症者之安全照護．台灣老人保健學刊，1.1（1），8-40。
林金定、嚴嘉楓、陳美花（2005）．質性研究方法:訪談模式與實施步驟分析．
身心障礙研究，3（2），122-135。
胡幼慧（1996）．質性研究的分析與寫成．於胡幼慧總校閱，質性研究-理論方
法及本土女性研究實例（一版，159-170頁)．台北：巨流。
陳向明（2002）．社會科學質的研究．台北：五南。
陳施妮、陳光琪、孫嘉玲（2007）．台灣地區護理人員護理能力特性分析．護理
導航，8（2），1-13。
許佩蓉、黃耀榮、林健群、陳永煌、羅慶徽、李世代（2004）．居住型態對照護
機構內失智症患者問題行為之可能影響．台灣家醫誌，14（1），13-24。
高潔純（2004）．機構失智長者的問題行為．長期照護雜誌，8（2），251-261。
劉樹泉（2004）．醫療溝通與人際關係．台北：合記。
劉景寬（2001）．老人痴呆症是無藥可救的嗎？失智症的治療現況．高醫醫訊月
刊，21（4），13-16。
劉嘉逸、劉秀枝（2000）．阿茲海默症之非認知症狀．應用心理研究，7，89-103。
張可臻、陳昭源、林忠順（2008）．失智症合併精神行為症狀的診斷及治療照護．
基層醫學，23（6），153-157。
Acton, G. J., Mayhew, P. A., Hopkins, B. A., & Yauk, S. (1999). Communicating with
individuals with dementia. The impaired person's perspective. Journal of
Gerontology Nursing, 25(2), 6-13.
Alzheimer's Association. (2005). Communication. Retrieved October 3, 2009,
from http://www.alz.org/living_with_alzheimers_communication.asp
Alzheimer's Association. (2008). Alzheimer’s disease facts and figures. Retrieved September 11, 2008, from http://www.alz.org/national/ documents/report _alzfactsfigures2008.pdf
Alzheimer's Association. (2008). Behavioral symptoms. Retrieved October 1, 2009, from http://www.alz.org/professionals_and_researchers _behavioral_symptoms _pr.asp
Alzheimer Society of Canada. (2007). Communication. Retrieved October 3, 2009, from http://www.alzheimer.ca/english/care/dailyliving-communication.htm
Alzheimer Society of Canada. (2008). What is Alzheimer's disease? Changes in the brain. Retrieved October 3, 2009, from http://www.alzheimer.ca/
english/disease/whatisit-brainchanges.htm
Antai-Otong, D. (2007). Nurse-client communication : A life span approach. Sudbury, Mass: Jones and Bartlett.
Armstrong, M. (2000). Factors affecting the decision to place a relative with dementia
into residential care. Nursing Standard, 14(16), 33-37.
Aveyard, B. (2001). Education and person-centered approaches to dementia care.
Nursing Older People, 12(10), 17-19.
Barrere, C. C. (2007). Discourse analysis of nurse-patient communication in a
hospital setting: Implications for staff development. Journal of Nurses Staff
Development, 23(3), 114-122.
Brodaty, H., Draper, B., & Low, L. F. (2003). Nursing home staff attitudes towards
residents with dementia: Strain and satisfaction with work. Journal of Advanced
Nursing, 44(6), 583-590.
Bowles, N., Mackintosh, C., & Torn, A. (2001). Nurses' communication skills: An
evaluation of the impact of solution-focused communication training. Journal of
Advanced Nursing, 36(3), 347-354.
Black, K., & Emmet, C. (2006). Nurses' Advance Care Planning Communication: An
Investigation. Geriatric Nursing, 27(4), 222-227.
Balandin, S., Hemsley, B., Sigafoos, J., & Green, V. (2007). Communicating with
nurses: The experiences of 10 adults with cerebral palsy and complex
communication needs. Applied Nursing Research, 20(2), 56-62.
Bryan, K., & Maxim, J. (2006). Communication disability in the Dementias.
London: Whurr.
Bayles, K. ＆ Tomoeda, C. (2007). Cognitive-Communication Disorders of
Dementia. San Diego, CA: Plural.
Burgio, L. D., Allen-Burge, R., Roth, D. L., Bourgeois, M. S., Dijkstra, K., Gerstle, J.,
et al. (2001). Come talk with me: Improving communication between nursing
assistants and nursing home residents during care routines. Gerontologist, 41(4),
449-460.
Boyatzis, R. E. (2005)．質性資料分析 :如何透視質性資料（王國川、翁千惠譯）．
台北：五南。（原著出版於1998）
Chan, D. C., Kasper, J. D., Black, B. S., & Rabins, P. V. (2003). Presence of
behavioral and psychological symptoms predicts nursing home placement in
community-dwelling elders with cognitive impairment in univariate but not
multivariate analysis. Journal of Gerontology, 58(6), 548-554.
Clare, L., Rowlands, J., Bruce, E., Surr, C., & Downs, M. (2008). 'I don't do like I
used to do': A grounded theory approach to conceptualising awareness in people
with moderate to severe dementia living in long-term care. Social Science &
Medicine, 66(11), 2366-2377.
Colling, K. B. (2004). Caregiver interventions for passive behaviors in dementia:
Links to the NDB model. Aging Mental Health, 8(2), 117-125.
Cohen-Mansfield, J., & Mintzer, J. E. (2005). Time for change: The role of
nonpharmacological interventions in treating behavior problems in nursing home
residents with dementia. Alzheimer Disease & Associated Disorders, 19(1),
37-40.
Cook, C., Fay, S., & Rockwood, K. (2009). Verbal repetition in people with
mild-to-moderate Alzheimer Disease: A descriptive analysis from the VISTA
clinical trial. Alzheimer Disease & Associated Disorders, 23(2), 146-151.
Cunningham, J., & Williams, K. N. (2007). A case study of resistiveness to care and
elderspeak. Research & Theory for Nursing Practice, 21(1), 45-56.
Calcagno, K. M. (2008). Listen Up … Someone Important Is Talking. Home
Healthcare Nurse, 26(6), 333-336.
Evans, L. K., & Cotter, V. T. (2008). Avoiding restraints in patients with dementia:
Understanding, prevention, and management are the keys. American Journal of
Nursing, 108(3), 40-49.
Edwards, N., Peterson, W. E., & Davies, B. L. (2006). Evaluation of a multiple
component intervention to support the implementation of a 'Therapeutic
Relationships' best practice guideline on nurses' communication skills. Patient
Education Counseling, 63(1-2), 3-11.
Finset, A. (2007). Nonverbal communication-An important key to in-depth
understanding of provider-patient interaction. Patient Education Counseling,
66(2), 127-128.
Fessey, V. (2007). Patients who present with dementia: Exploring the knowledge of
hospital nurses. Nursing Older People, 19(10), 29-33.
Finke, E. H., Light, J., & Kitko, L. (2008). A systematic review of the effectiveness of
nurse communication with patients with complex communication needs with a
focus on the use of augmentative and alternative communication. Journal of
Clinical Nursing, 17(16), 2102-2115.
Goode, M. L. (2004). Communication barriers when managing a patient with a
wound. British Journal of Nursing, 13(1), 49-52.
Grealy, J., McMullen, H., ＆ Grealy, J. (2005). Dementia care: A practical
photographic guide. Malden, MA: Oxford.
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content
analysis. Qualitative health research, 15(9), 1277-1288.
Hemsley, B., Sigafoos, J., Balandin, S., Forbes, R., Taylor, C., Green, V. A., et al.
(2001). Nursing the patient with severe communication impairment. Journal of
Advance Nursing, 35(6), 827-835.
Huang, S-L, Li, C-M., Yang, C-Y., Chen, J. J. (2009). Application of Reminiscence
Treatment on Older People With Dementia: A Case Study in Pingtung, Taiwan.
Journal of Nursing Research. 17(2), 112-119,
Hendry, K. C., & Douglas, D. H. (2003). Promoting quality of life for clients
diagnosed with dementia. Journal of the American Psychiatric Nurses
Association, 9(3), 96-102.
Janicki, M. P., ＆ Dalton, A. J. (1999). Maintaining communication. In McCallion,
P. (Ed.), Dementia, aging, and intellectual disabilities : A handbook (2nd ed., pp.
261-277). New York: Rout ledge.
Jones, A. (2003). Nurses talking to patients: Exploring conversation analysis as a
means of researching nurse-patient communication. International Journal of
Nursing Studies, 40(6), 609-618.
Jonsdottir, H., Jonsdottir, G., Steingrimsdottir, E., & Tryggvadottir, B. (2001). Group
reminiscence among people with end-stage chronic lung diseases. Journal of
Advanced Nursing, 35(1), 79-87.
Jorgensen, D. L.（1999）．參與觀察法（王昭正、朱瑞淵譯）．臺北：弘智文化。
（原著出版於1989）
Kolanowski, A. M., Litaker, M. S., & Catalano, P. A. (2002). Emotional well-being in
a person with dementia. Western Jourrnal of Nursing Research, 24(1), 28-43.
Kettunen, T., Poskiparta, M., & Liimatainen, L. (2001). Empowering counseling-a
case study: Nurse-patient encounter in a hospital. Health Education Research,
16(2), 227-238.
Krippendorff, K. (2004). Content analysis : An introduction to its methodology.
Thousand Oaks, CA: Sage.
Kovach, C. R., Noonan, P. E., Schlidt, A. M., Reynolds, S., & Wells, T. (2006). The
serial trial intervention: An innovative approach to meeting needs of individuals
with dementia. Journal of Gerontology Nursing, 32(4), 18-25.
Kovach, C. R., Noonan, P. E., Schlidt, A. M., & Wells, T. (2005). A model of
consequences of need-driven, dementia-compromised behavior. Journal of Nursing Scholarship, 37(2), 134-140.
Kuske, B., Luck, T., Hanns, S., Matschinger, H., Angermeyer, M. C., Behrens, J., et
al. (2009). Training in dementia care: A cluster-randomized controlled trial of a
training program for nursing home staff in Germany. International
Psychogeriatrics, 21(2), 295-308.
Levy-Storms, L. (2008). Therapeutic communication training in long-term care
institutions: Recommendations for future research. Patient Education and
Counseling, 73(1), 8-21.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
Lambert, A. J., Payne, B. K., Jacoby, L. L., Shaffer, L. M., Chasteen, A. L., & Khan,
S. R. (2003). Stereotypes as dominant responses: On the "social facilitation" of
prejudice in anticipated public contexts. Journal of Personality and Social
Psychology, 84(2), 277-295.
Lawrence, V., Murray, J., Ffytche, D., & Banerjee, S. (2009). "Out of sight, out of
mind": A qualitative study of visual impairment and dementia from three
perspectives. International Psychogeriatrics, 21(3), 511-518.
Martin, D. R., & Tipton, B. K. (2007). Patient advocacy in the USA: Key
communication role functions. Nursing & Health Science, 9(3), 185-191.
Markova, T., & Broome, B. (2007). Effective communication and delivery of
culturally competent health care. Urologic Nursing, 27(3), 239-242.
Miller, L. (1995). The human face of elderly care? Complement Therapies of Nursing
＆ Midwifery, 1(4), 103-105.
Miller, C. A. (2008). Communication difficulties in hospitalized older adults with
dementia. American Journal of Nursing, 108(3), 58-66.
Mayhew, P. A., Acton, G. J., Yauk, S., & Hopkins, B. A. (2001). Communication
from individuals with advanced DAT: Can it provide clues to their sense of
self-awareness and well-being? Geriatric Nursing, 22(2), 106-110.
Miceli, D. G. (2005). Falls associated with dementia: How can you tell? Geriatric
Nursing, 26(2), 106-110.
McCabe, C. (2004). Nurse-patient communication: An exploration of patients'
experiences. Journal of Clinical Nursing, 13(1), 41-49.
McCallion, P., Toseland, R. W., Lacey, D., & Banks, S. (1999). Educating nursing
assistants to communicate more effectively with nursing home residents with dementia. Gerontologist, 39(5), 546-558.
Medline Plus. (2008). Dementia. Retrieved October 17, 2008, from
http://www.nlm.nih.gov/medlineplus/dementia.html
Naylor, E., & Clare, L. (2008). Awareness of memory functioning, autobiographical
memory and identity in early-stage dementia. Neuropsychological
Rehabilitation, 18(5-6), 590-606.
National Institute on Aging. (2008). Alzheimer's Disease fact sheet.
Retrieved September 25, 2008, from http://www.nia.nih.gov/Alzheimers/ Publications/adfact.htm
National Institute on Aging. (2008). Alzheimer's Information.
Retrieved September 27, 2008, from http://www.nia.nih.gov/Alzheimers
/Alzheimers Information/GeneralInfo/#howmany
Nordby, H. (2007). Meaning and normativity in nurse-patient interaction. Nursing
Philosophy, 8(1), 16-27.
Nordby, H. (2006). Nurse-patient communication: Language mastery and concept
possession. Nursing Inquiry, 13(1), 64-72.
Neuendorf, K. A. (2002). The content analysis guidebook. Thousand Oaks, CA: Sage.
Norberg, A. (1996). Caring for demented patients. Acta neurologica
Scandinavica. Supplementum, 165, 105-108.
Nichols, M. P.（2002）．傾聽 :人際關係中溝通的藝術（邱珍琬譯）．台北：遠流。 （原著出版於1995）
Online etymology dictionary. (2001). Dementia. Retrieved October 16, 2008, from http://www.etymonline.com/index.php?search=dementia&search mode=nl
Penrod, J., Yu, F., Kolanowski, A., Fick, D. M., Loeb, S. J., & Hupcey, J. E. (2007).
Reframing person-centered nursing care for persons with dementia. Research
& Theory Nursing Practice, 21(1), 57-72.
Paquay, L., De Lepeleire, J., Milisen, K., Ylieff, M., Fontaine, O., & Buntinx, F.
(2007). Tasks performance by registered nurses and care assistants in nursing
homes: A quantitative comparison of survey data. International Journal of
Nursing Study, 44(8), 1459-1467.
Perry, J., Galloway, S., Bottorff, J. L., & Nixon, S. (2005). Nurse-patient
communication in dementia: Improving the odds. Journal of Gerontology
Nursing, 31(4), 43-52.
Potkins, D., Myint, P., Bannister, C., Tadros, G., Chithramohan, R., Swann, A., et al.
(2003). Language impairment in dementia: Impact on symptoms and care needs
in residential homes. International Journal Geriatric Psychiatry, 18(11),
1002-1006.
Poole, G., & Rowat, K. (1994). Elderly clients' perceptions of caring of a home-care
nurse. Journal of Advance Nursing, 20(3), 422-429.
Russell, C., & Timmons, S. (2009). Life story work and nursing home residents with
dementia. Nursing Older People, 21(4), 28-32.
Roth, D. L., Stevens, A. B., Burgio, L. D., & Burgio, K. L. (2002). Timed-event
sequential analysis of agitation in nursing home residents during personal care
interactions with nursing assistants. Journals of Gerontology, 57(5), P461-468.
Ruan, J., & Lambert, V. A. (2008). Differences in perceived communication barriers
among nurses and elderly patients in China. Nursing & Health Sciences, 10(2),
110-116.
Savundranayagam, M. Y., Ryan, E. B.,＆ Anas, A. P.＆ Orange, J. B. (2007).
Communication and Dementia: Staff Perceptions of Conversational Strategies.
Clinical Gerontologist, 31(2), 47-63.
Sheldon, L. K., Barrett, R., & Ellington, L. (2006). Difficult communication in
nursing. Journal of Nursing Scholarship, 38(2), 141-147.
Smith, M., & Buckwalter, K. (2005). Behaviors associated with dementia: Whether
resisting care or exhibiting apathy, an older adult with dementia is attempting
communication. Nurses and other caregivers must learn to 'hear' this language.
America Journal of Nursing, 105(7), 40-52.
Smith, M., Buckwalter, K. C., Kang, H., Ellingrod, V., & Schultz, S. K. (2008).
Dementia care in assisted living: Needs and challenges. Issues of Mental Health
Nursing, 29(8), 817-838.
Smith, G. E., Kokmen, E., & O'Brien, P. C. (2000). Risk factors for nursing home
placement in a population-based dementia cohort. Journal of America Geriatric
Social, 48(5), 519-525.
Steele, C., Rovner, Barry, Chase, Gary A, ＆ Folstein, M. (1990). Psychiatric
Symptoms and Nursing Home Placement of Patients with Alzheimer's Disease.
The American Journal of Psychiatry, 147, 1049–1051.
Schafer, P., & Peternelj-Taylor, C. (2003). Therapeutic relationships and
boundary maintenance: The perspective of forensic patients enrolled in a
treatment program for violent offenders. Issues of Mental Health Nursing,
24(6-7), 605-625.
Tappen, R. M., Williams-Burgess, C., Edelstein, J., Touhy, T., & Fishman, S. (1997).
Communicating with individuals with Alzheimer's disease: Examination of
recommended strategies. Archives of Psychiatric Nursing, 11(5), 249-256.
Trojan, L., & Yonge, O. (1993). Developing trusting, caring relationships: Home care
nurses and elderly clients. Journal of Advance Nursing, 18(12), 1903-1910.
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting
qualitative research (COREQ): A 32-item checklist for interviews and focus
groups. International Journal of Quality Health Care, 19(6), 349-357.
Verderber, R. F., ＆ Verderber, K. S.（1996）．人際關係與溝通（曾瑞真、
曾玲珉譯）．台北：揚智。（原著出版於1995）
Williams, C. L., Hyer, K., Kelly, A., Leger-Krall, S., & Tappen, R. M. (2005).
Development of nurse competencies to improve dementia care. Geriatric
Nursing, 26(2), 98-105.
Williams, K. N., Ilten, T. B., & Bower, H. (2005). Meeting communication needs:
Topics of talk in the nursing home. Journal of Psychosocial Nursing and Mental
Health Services, 43(7), 38-45.
Williams, K., Kemper, S., & Hummert, M. L. (2004). Enhancing communication with
older adults: Overcoming elderspeak. Journal of Gerontology Nursing, 30(10),
17-25.
Williams, K. N., Herman, R., Gajewski, B., & Wilson, K. (2009). Elderspeak
communication: Impact on dementia care. American Journal Alzheimer’s
Disease and Other Dementias, 24(1), 11-20.
World Health Organization, WHO. (2007). Global burden of dementia in 2000: Summary of methods and data sources. Retrieved September 27, 2008, from http://www.who.int/entity/healthinfo/statistics/bod_dementia.pdf
Wu, H. Z. Y., Low, L.-F., Xiao, S., & Brodaty, H. (2009). A pilot study of differences
in behavioral and psychological symptoms of dementia in nursing home
residents in Sydney and Shanghai. International Psychogeriatrics, 21(3),
476–484.
Wood, J. T. (2005). Gendered lives :Communication, ender & culture. Belmont,
CA : Wadsworth.
Yi, M., & Yih, B. S. (2006). A conversation analysis of communication between
patients with dementia and their professional nurses. Taehan Kanho Hakhoe Chi
in Korea, 36(7), 1253-1264.
Zimmerman, S., Sloane, P. D., Williams, C. S., Reed, P. S., Preisser, J. S., Eckert, J.
K., et al. (2005). Dementia care and quality of life in assisted living and nursing
homes. Gerontologist, 45(1), 133-146.
Zimmerman, S., Williams, C. S., Reed, P. S., Boustani, M., Preisser, J. S., Heck, E., et
al. (2005). Attitudes, stress, and satisfaction of staff who care for residents with
dementia. Gerontologist, 45(1), 96-105.