健康相關生活品質越來越重視病人主觀的感受，然而將這個部分納入測量之後，許多研究結果卻出現殘疾悖論(disability paradox)的現象，也就是重度疾病病人的自評生活品質並不比程度輕微或甚至健康的人差。反應轉移理論認為，造成這個現象的原因在於個人的自評生活品質會受到個體對於生活品質定義的改變（重新構念）、內在測量尺度標準的改變（重新校準）、以及價值的改變（重新權重）的影響，到目前為止，反應轉移尚未發展出合適的測量工具。 SEIQoL-DW (Schedule for the Evaluation of Individual Quality of Life- direct weighting)做為一個生活品質測量個人化的代表，其評估分成三個步驟，分別是提名重要的生活領域、評估提名領域的滿意程度、以及評估提名領域的相對權重，許多研究者嘗試用SEIQoL-DW在兩點間的領域變化做為重新構念，權重變化做為重新權重，重新校準則需要搭配then test來測量，then test是在第二個測量點時邀請受試重新對第一個時間點的提名領域進行評估，然而這三個成分指標的操作型定義不一，then test也有使用上的不便，同時過去這些指標對生活品質的效用檢驗也都未達顯著。本研究分認為，若能解決上述的問題，將有助於解釋殘疾悖論，同時可以區辨不同類別病人的反應轉移模式，並運用在臨床來幫助病人進行調適。 本研究以立意取樣招募3期以上之慢性腎臟病患者、以及血液透析、腹膜透析未滿一年以上之三組病患共85名，除了背景和臨床資料外，在間隔三個月的兩點分別填寫SEIQoL-DW、ideal scale（評估期待）、生活滿意問卷、正負向情緒問卷，並在後測時填寫then test。研究結果顯示，三組病人的生活品質符合殘疾悖論，並無顯著差別。重新構念、重新校準、和重新權重當中，僅重新校準有助於生活品質的提升，並能夠顯著解釋生活品質的改變。 對腎臟病患者來說，期待越高，生活品質提升得越多，進一步的分析顯示，受試會捨棄相對權重較低的領域，新提名領域的滿意程度、期待、和相對權重都顯著高於捨棄的舊領域，這可以作為臨床上協助病人調適的策略。雖然then test的結果顯著，但實證結果和理論卻相當混亂，尚待未來研究釐清。 / Health-related quality of life (HRQoL) is increasingly recognized as being subjective, which emphasized patient-reported outcomes. Many HRQoL studies reported that people with serious illness perceived no less quality of life (QoL) than those without such illness. This phenomenon is labeled as disability paradox. Response shift theory provides an explanation for it and refers to a change in the meaning of one’s self-evaluation of QoL as a result of changes in internal standards (recalibration), values (reprioritization), and reconceptualization of QoL. It is these changes that will influenced perceived QoL. Current methods to detect Response Shift are still evolving. SEIQoL-DW (Schedule for the Evaluation of Individual Quality of Life- direct weighting) is one of individualized QoL instruments and measures three elements of QoL, including five important aspects of life, current satisfaction with each aspect, and relative importance of each aspect. Many researchers tried to use SEIQoL-DW to detect response shift. Changes in the content of aspects of life between two time points reflect reconceptualization. Changes in the relative weighting between two time points reflect reprioritization. Recalibration is measured by then test, which is a method by asking respondents at time two to provide a renewed rating of their aspects of life given at time one. However, there are no consensus operational definition of indices of reconceptualization , reprioritization, and recalibration. The examination between indices and improvements in QoL was not significant, either. Besides, then test with SEIQoL-DW has a disadvantage when aspects nominated between time one and two are different. This study tried to resolve issues above. If these issues are resolved, disability paradox will be explained. Response Shift will possibly differentiate patients of various disease, and provide ideas to help patients adjust to illness. 85 patients were recruited, including those with renal disease stage 3-5, and those undergoing hemodialysis or peritoneal dialysis within one year. All patients completed SEIQoL-DW, ideal scale, Satisfaction with Life Scale, the Positive And Negative Affect Scale at time one and three months after , except questionnaire on personal background and biological information (at time one) and then test (at time two). Results indicated that the QoLs of these three groups of patients showed no different, which confirmed disability paradox. Only recalibration showed helpful. Regression analyses also showed that recalibration indices were better predictors in QoLs. For End-stage Renal Disease patients, higher expectation suggested higher QoL improvement. Further analysis showed that patients would abandon lower-weighted aspect of life. Compared to the abandoned aspects, higher satisfaction, expectation and weighting were seen in new-nominated aspect. This finding could be useful in helping patients adjust. Although then test also reached significance, evidences was contradicted to its prediction. More research is needed in the future.

本研究旨在瞭解臺北市政府都市發展局(以下簡稱都發局)員工工作生活品質與工作績效關聯之現況，探討個人屬性在工作生活品質與工作績效之差異性，及工作生活品質與工作績效間相關性，研究並提供為主管機關改善都發局員工工作生活品質及工作績效參考，提升組織效能。 本研究係採問卷調查法，問卷經預試修正後，以臺北市政府都市發展局為研究母群體，採抽樣調查方式施測，共202份有效問卷。研究問卷內容包括工作生活品質量表、工作績效表及個人基本資料。問卷資料蒐集運用電腦統計套裝軟體SPSS 進行統計與分析，以敘述性統計分析、獨立樣本T檢定、單因子變異數分析、相關分析及多元迴歸分析等推論性統計方法來進行資料處理，本研究經實證研究分析，歸納結果如下： 一、都發局員工對工作生活品質知覺平均有70.79%表示滿意。各因素平均數比率，以「工作層面」最高(73.44%)，其次為「組織層面」(70.24%)，以「個人層面」最低(66.20%)。 二、都發局員工對工作績效程度平均有75.95%表示認同。各因素平均數比率，以「脈絡性績效」最高(79.83%)，其次為「適應性績效」(74.70%)，以「任務性績效」最低(72.30%)。 三、不同個人背景屬性之都發局員工對工作生活品質知覺之差異情形，其中教育程度具有顯著差異存在。 四、不同個人背景屬性都發局員工對工作績效程度之差異情形，其中職務、婚姻狀況、年齡及本機關服務年資等四項具有顯著差異存在。 五、工作生活品質及其因素與工作績效間均具正相關性。 六、工作生活品質構面中「個人層面」及「工作層面」構面等因素對「任務性績效」具有16.3%預測力；另「個人層面」因素對「脈絡性績效」具有19.2%預測力；「個人層面」因素對整體「工作績效」具有19.8%預測力。 根據實證研究及統計分析結果，提出建議如下: 一、對機關行政管理上之建議:增加員工的工作成就感；適度調整福利待遇，以提升員工士氣；建立公平的升遷、考核制度；激發同仁的團隊合作；建立職務輪調機制；定期舉辦員工與局長有約，以瞭解基層心聲。 二、對人事單位之建議：改善機關的獎勵作業方式；增加多元化的訓練課程；加強員工尊榮感；協助員工轉介協談，紓解工作壓力。 三、對員工個人之建議：強化個人對工作的正向思考；加強學習新知的動力；勇於面對環境的變動與未來的挑戰。 關鍵詞：工作生活品質、工作績效、臺北市政府都市發展局 / The purpose of this research is to understand the situation of quality of working life and job performance of civil service personnel of urban development bureau of taipei city government. It discusses the differences of personal property between quality of working life and job performance and the relationship between quality of working life and job performance. It also provides advices for controlling organization to improve the quality of working life and job performance of civil service personnel to increase organization efficiency. Questionnaire survey method is employed in this research while it makes use of urban development bureau of taipei city government and its affiliated civil service personnel as its subjects of research. There are 202 copies of questionnaire are valid. The content of questionnaire includes the scale for quality of working life, scale for job performance of employee and personal information.It uses statistic software SPSS to analyze these data.Descriptive statistics analysis, t-Test, One way ANOVA, Pearson product-moment correlation and multiple-regression analysis are used to process these information. The results are as follows: 1. An average of 70.79% of urban development bureau of taipei city government and its affiliated civil service personnel present their degree of satisfaction about quality of working life.The degree of satisfaction with “work stratification plane” is the highest among all factors (73.44%), and others in order are: “organization stratification plane (70.24%),” and “individual stratification plane (66.20%).” 2. An average of 75.95% of urban development bureau of taipei city government and its affiliated civil service personnel has shown their agreement on job performance.The degree of satisfaction with “contextual performance” is the highest among all factors (79. 83%), and others in order are: “adaptive performance (74.70%),”and “task performance (72.30%)”. 3. Different backgrounds of the public official of urban development bureau have shown different degree of perceptions about quality of working life. Among all the factors, educational background have the most obvious difference. 4. Different backgrounds of the public official of urban development bureau have shown different degree of perceptions about job performance. Among all the factors, position,marital status ,age and the age service seniority have the most obvious difference. 5. Between the quality of working life and the job performance, their factors are all positive related. 6. In the aspect of the quality of working life, it is found that employees have a 16.3% of predicting power to “task performance” regarding the factors of “individual stratification plane ” and “work stratification plane”; There is a 19.2% of predicting power to“contextual performance” regarding the factors of “individual stratification plane”; There is a 19.8% of predicting power to job performance regarding the factors of “individual stratification plane”. According to the research and statistic analysis, suggestions are presented as follows: 1. The recommendation of administrative management: Increasing employee job satisfaction; Appropriately adjust the benefits to boost staff morale;Establishing a fair promotion and performance appraisal system;Inspired team of colleagues;Establishment of job rotation mechanism;. 2. The recommendation of the personnel unit: Practices to improve the agency's award; Increasing a variety of training courses ; Increasing in staff a sense of honor; On the referral agreement to help staff to relieve work pressure;Regular discussions with employees to understand the aspirations of the grassroots. 3. The recommendation of personal:Strengthening the positive thinking individuals to work ;Enhancing motivation to learn new knowledge;The face of environmental changes and future challenges. Keywords: quality of working life, job performance, urban development bureau of taipei city government

本研究旨在探討智能障礙者雙老家庭之照顧負荷、家庭復原力與家庭生活品質的關係，並檢驗家庭復原力對照顧負荷與家庭生活品質之調節情形。 本研究採取問卷調查法，採便利取樣方式進行資料蒐集工作，研究對象為79戶雙老家庭。資料分析以t考驗、單因子變異數分析、皮爾森積差相關分析與階層迴歸分析進行。研究主要結果如下： 一、雙老家庭的照顧負荷程度高，然家庭復原力及家庭生活品質的現況表現也普遍較高； 二、照顧負荷與家庭復原力具有顯著負相關； 三、照顧負荷與家庭生活品質具有顯著的負相關； 四、家庭復原力與家庭生活品質具有顯著的正相關； 五、家庭復原力可調節照顧負荷對家庭生活品質之負向效果。 本研究根據問卷調查結果，提出實務與後續研究之建議。 / The purpose of this study was to probe into the relations between care burden, family resilience and family quality of life of the double-ageing families that contain old parents and their children with intellectual disability, and to examine the moderating effects of the family resilience of care burden and the family quality of life. A questionnaire survey was used in the study which recruited 79 double-ageing families. The data of questionnaire survey were analyzed by t-test, one-way ANOVA, Pearson product-moment analysis, and hierarchical regression analysis. The results of the study were described as the followings： 1.Care burden of caregiver is in high-level；Family resilience and family quality of life levels of double-ageing families are positive, between mid-level and high-level. 2.There was significant negative correlation between care burden and family resilience. 3.There was significant negative correlation between care burden and family quality of life. 4.There was significant positive correlation between family resilience and family quality of life. 5.The family resilience moderated the negative effects of the family quality of life caused from care burden. Based on the results from the questionnaire survey, some suggestions for practice and future studies were proposed.

因為醫病互動關係的改變，病患自主權在經過歐美數十年來的覺醒與詮釋，並定位於不論是人性尊嚴或是隱私權內涵中之憲法層級，以及在告知後同意於近二十年來引進國內並蓬勃發展之後，病患的自主決定權在現今醫療過程中已經受到相當的重視。青少年也因接近成人的年齡及成熟度，在法律及臨床實務上也逐漸肯認其對於自身的醫療決定擁有自主決定權。然而，兒童不論在法律或是社會觀念之中，均被認定為能力尚未成熟，傳統上認為必須由父母代替其做醫療決定。可是在作者身為一位臨床兒科醫師的臨床實務經驗當中，許多病童往往能表達自己對於醫療決定甚至是臨終決定的自主意見，卻不受到父母或其他成年代理人的採納。 因此，本文將從臨床經驗出發，將所發現許多兒童有能力決定、以及父母無法做出符合兒童利益決定的案例，提出作為本文探討的思考起源。本文主要鎖定未成年人中未滿12歲的兒童進行討論，排除許多文獻早已熱烈討論的青少年人；另外因為立法例上並未賦予未成年人擁有「自主權」，故本文暫不深究兒童法律上的自主權利，而是以探討兒童實質上的「自主性」作為探討的主軸，並以此為未來法律發展的基礎。 本文將首先從「醫病關係的演進」開始，探討一般性「病患自主決定權」之倫理與法律。醫學倫理上涉及包括「生物醫學倫理四原則」以及「告知後同意」；多數國家也將「自主決定權」在法律上定位為憲法層級之人權保障。聯合國兒童權利公約則為現今國際上兒童人權維護的重要指引，也是對於兒童一般自主權正當性的重要依據。至於兒童的自主決定與其決定能力相關，也涉及父母代理決定的討論，故從法律上對於父母子女關係及未成年人保護的討論出發，探討代理決定時的最佳利益判斷，思考兒童醫療決定的問題及衝突，以及在不同年齡適合該年齡得以決定的事項。 在兒童醫療決定上，難題包括為何要重視兒童自主、何人有權決定、如何決定等等，在此議題受到各國重視並不斷發展之下應如何運作。在本文中主要參考了美國以及英國的發展經驗以及建議，提出對於臨床操作的看法。本文認為，可以用兒童醫療「表意權」的行使作為對兒童自主性的肯認，從兒童決定能力的判斷開始，對於具有決定能力的兒童表達其合理意見應充分尊重；若是缺乏決定能力的兒童，則在考量其最佳利益後由父母代理其做出醫療決定。醫療人員基於必須對於病童負責的角色及責任，亦應檢視父母決定是否合理，適時地介入決定以維護兒童最佳利益。 至於在兒童的最佳利益的判斷上，除了要考慮所面對的病況以外，還需要針對兒童未來生理發育和心智發展的影響，整體考量其未來的生活品質；對於臨終的兒童，則應考量是否得到有尊嚴的死亡，此與成年人的思考並無相左。最後，本文將進一步探討較為特殊的臨床狀況，包括面對重症以及急症的病童應如何操作及思考，並重新檢視本文所提出之實際臨床困難案例，建議較為適合的做法，以作為更多臨床個案判斷的參考指引。 / Patients' awareness of self-determination has raised and their rights have been taken into account in clinical consideration because of the change of doctor-patient relationship in recent decades. The right to autonomy was highly positioned at the constitutional level no matter it is contained in the concept of human dignity or the right of privacy. It is also highly valued after “the doctrine of informed consent” was introduced into our country with vigorous development in recent years. Because adolescents’ age and maturity approach adults, they have been recognized to have sufficient ability and right to make their own medical decisions as well as adults. Children, in the general idea of the society, are concerned not to have sufficient decision making ability and therefore need their parents’ help to make their own medical decisions. However, from clinical experiences, many children could not only express their autonomous opinions but even have the ability to consent to their medical treatments, including life-saving treatments. Unfortunately, children’s opinions were usually ignored, and sometimes their parents could not make decisions in their best interest. This study will discuss the patient autonomy of children whose ages are under 12 years old. We acknowledge that children do not have legal “right” to autonomy but they still have their own autonomous expression. The ethical and legal bases of patient autonomy are firstly illustrated, including “the four principles approach to bioethics”, “the doctrine of informed consent”, the legal status of “the right to autonomy” at the constitutional level, and the United Nations Convention on the Rights of the Child which is an international guide to children’s human right. Children’s autonomy is closely related to their decision-making capacity or competence and their age. Furthermore, surrogate decision making plays an important role in children’s affairs. When there is a conflict between the parents and children, the principle of best interest of children should be the leading concern. Regarding the medical decision of children, difficult problems are: why children’s patient autonomy is vital, who has the right to decide, and how to make a decision. I have reviewed the experiences and suggestions from concept leading countries such as the United States and the United Kingdom. I proposed my own viewpoint and suggest some guidelines on the clinical decision process. My opinion is that children’s right to express should be taken as the confirmation of children’s autonomy. For the children with decision making capacity, we should fully respect his rational decision; for the children without it, parents could make the decisions according to the children’s best interest. Medical staffs, including doctors and nurses, also need to reexamine the parents’ decisions suitable for children’s best interest. At the end of the thesis, I re-examine the clinical cases proposed at the beginning of this thesis, to present my resolution to the cases as guides for future clinical situation.

本研究之目的在於以Sternberg的WICS模式、以及Hamel與Prahalad的競爭大未來思維為出發點，探討當領導者具備智慧、實用智力、分析智力、創造力、以及競爭大未來思維時，是否能制定較佳的決策，進而影響到員工的工作生活品質、身心健康、與幸福感，最終則對於組織競爭力與組織績效產生影響。此外，本研究也檢驗「領導競爭力之整合模式」，以協助企業組織進行診斷與改善。 本研究以問卷蒐集資料，並採用便利取樣，共蒐集417位員工的有效樣本，與經過信度、效度、與因素分析的檢驗，再進行變項間的關係探討。統計分析結果顯示，本研究多數量表皆具有良好的內部一致性信度(.93~.97)與效標關聯效度(.14~.88)。此外，本研究以階層迴歸分析與結構方程模式驗證本研究假設，研究結果顯示：1. 領導者智慧、領導者智力、領導者創造力、與競爭大未來思維，對於領導者決策品質具有正向顯著影響；2. 領導者決策品質對員工工作生活品質具有正向顯著影響；3. 員工工作生活品質對於員工身心健康具有正向顯著影響；4. 員工身心健康對於員工幸福感具有正向顯著影響；5. 員工幸福感對於組織競爭力具有正向顯著影響；6. 組織競爭力對於組織績效具有正向顯著影響；7. 領導者智慧、領導者智力、領導者創造力、與競爭大未來思維，對於組織績效具有正向顯著影響；8. 本研究之領導競爭力整合模式獲得支持。 最後，本研究提出未來之研究建議，以期未來研究能以更完善的研究設計，獲得更完整的領導競爭力之全貌，同時，亦提出本研究之實務應用建議，以作為企業組織診斷與發展的重要參考。