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  1. NTU Theses and Dissertations Repository
  2. 社會科學院
  3. 社會工作學系
請用此 Handle URI 來引用此文件: http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/99181
完整後設資料紀錄
DC 欄位值語言
dc.contributor.advisor謝宛蓉zh_TW
dc.contributor.advisorWan-Jung Hsiehen
dc.contributor.author張淇安zh_TW
dc.contributor.authorChi-An Changen
dc.date.accessioned2025-08-21T16:42:20Z-
dc.date.available2025-08-22-
dc.date.copyright2025-08-21-
dc.date.issued2025-
dc.date.submitted2025-08-05-
dc.identifier.citation一、中文部分
王柳婷(2013)。〈論失落經驗及個體之悲傷反應(一)〉,《北護校訓電子期刊》。取自https://acadsys.ntunhs.edu.tw/Periodical-eNews/views/fullArticlePage.php?id=1102&period=149。
吳芝儀(譯)(2008)。《敘事研究:閱讀、分析與詮釋》(原作者:Lieblich, A., Tuval-Mashiach, R., & Zilber, T.)。嘉義:濤石。(原著出版年:1998 年)
吳怡萱(2019)。〈在生命的起點說再見~談新生兒安寧緩和醫療〉,《長庚醫訊》,40(6),187-189。
吳慧娜、歐名哲、張永生、黃禮偉、林陳立(2006)。〈臺北市立聯合醫院出生通報資料分析:2002-2003〉,《北市醫學雜誌》,3(4),385-396。https://doi.org/10.6200/TCMJ.2006.3.4.09
吳麗珍、周傳姜、林妍君(2017)。〈哀傷理論於喪親家屬之護理應用〉,《護理雜誌》,64(6),98-105。
李佩珊(2019)。〈Bronfenbrenner 生態系統理論的近期發展與應用〉,《輔導季刊》,55(3),14-24。
李政賢(譯)(2014)。《質性研究:設計與計畫撰寫》(原作者:Marshall, C., & Rossman, G. B.)。台北:五南。(原著出版年:2006年)
李開敏、林方皓、張玉仕、葛書倫(譯)(2004)。《悲傷輔導與悲傷治療:心理衛生實務工作者手冊》(原作者:Worden, J. W.)。台北:心理。(原著出版於2001)
李惠玲、林淑珊、張秀能(2006)。〈一位因胎兒異常需終止妊娠婦女的護理經驗。志為護理〉,《慈濟護理雜誌》,5(2),118-132。https://doi.org/10.6974/TCNJ.200604.0118
李琇婷、呂旭亞(2011)。〈悲傷剝奪概念簡介-談諮商師的悲傷剝奪經驗〉,《諮商與輔導》,(310),43-50。
杜盈瑩(2023)。〈「陪伴」就是在需要的人身邊〉。於施麗雯(主編),停泊:自然流產支持手冊(頁8-9)。社團法人台灣生育改革行動聯盟。
社團法人台灣蒲公英小產協會(2024年5月24日)。〈天使媽媽的小產故事〉。取自https://www.facebook.com/share/p/1EkuNycvxr/。
宋麗玉、施教裕(2010)。〈復元與優勢觀點之理論內涵與實踐成效:臺灣經驗之呈現〉,《社會科學論叢》。4(2),2-34。https://doi.org/10.30401/RSS.201010_4(2).0001
林青燕、周瓊慧、林美慧(2022)。〈以周產期安寧照護概念協助一位因胎兒異常選擇終止妊娠孕母的護理經驗〉。《長庚護理》,33(3),121-131。https://doi.org/10.6386/CGN.202209_33(3).0011
林美珠、溫錦真(2018)。〈臺灣心理與諮商敘事研究之回顧與展望〉,《中華輔導與諮商學報》,(53),81-116。https://doi.org/10.3966/172851862018100053004
洪小媜、彭美瑛、李孟蓉(2017)。〈一位因胎兒異常接受終止妊娠婦女面臨哀傷之護理經驗〉,《助產雜誌》,59,46-57。https://doi.org/10.6518/TJOM.201712_(59).0005
唐先梅、曾敏傑(2008)。〈罕見疾病家庭的壓力源:一項探索式的質化研究〉。《特殊教育研究學刊》,33(2),47-70。https://doi.org/10.6172/BSE200807.3302003
梁梓敦(2021)。《我永遠是你們的孩子》。香港:dirty press。
孫瑞瓊、黃慧琪、許樹珍(2010)。〈夫婦面對胎兒異常接受終止妊娠之經驗歷程〉。《長庚科技學刊》,(13),55-64。http://doi.org/10.6192/CGUST.2010.12.13.6
陳亞嵐、吳羽楠、王珊珊、錢小芳(2016)。〈胎兒異常引產孕產婦應對策略的質性研究〉,《護理學報》,23(20),72-75。
陳慧怡、張詒舒、賴芊孝(2021)。〈照顧一位乳癌初產婦因胎兒異常面臨終止妊娠之護理經驗〉,《領導護理》,22(1),38-53。
陳馥萱(2015)。發展胎兒死亡事件之照護模式—行動研究法之應用。[博士論文。國立台灣大學]。https://doi.org/10.6342/NTU.2015.02291
陳馥萱、王素秋(2011)。〈以家庭生態系統觀點論死產婦女的處境與健康〉,《助產雜誌》,53,12-16。https://doi.org/10.6518/TJOM.2011.53.2
陳馥萱、余玉眉(2012)。〈生命末期的另一個照護議題:周產期安寧照護〉,《安寧療護雜誌》,17(3)。329-339。http://dx.doi.org/10.6537/TJHPC.2012.17(3).7
章薇卿(譯)(2007)。《走在失落的幽谷:悲傷因應指導手冊》(原作者:Neimeyer, R. A.)。新北:心理。(原著出版年:1998 年)
詹莉莉、康美玉(2009)。〈照顧一位胎兒異常初產婦接受終止妊娠之護理經驗〉,《助產雜誌》,51,35–42。 https://doi.org/10.6518/TJOM.2009.51.8
詹耀龍(2008)。〈面對孕婦與胎兒的道德兩難〉,《長庚醫訊》,29(9),273-274。
蔡汶樺(2013)。〈懷有先天性異常之胎兒婦女孕產護理經驗〉,《源遠護理》,7(1),45-50。https://doi.org/10.6530/YYN.2013.7(1).07
蔡佩真(2012)。〈華人家庭關係脈絡中悲傷表達模式之探討:以台灣經驗為例〉,《台灣心理諮商季刊》,4(1),16-38。
衛生福利部國民健康署(2018a)。《105年家庭與生育調查報告》。取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=243&pid=1291
衛生福利部國民健康署(2018b)。《出生通報統計年報》。取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=649&pid=11780
衛生福利部國民健康署(2020a)。《準爸媽攻略大公開!國健署懶人包告訴你》。取自https://www.mohw.gov.tw/cp-4626-56096-1.html
衛生福利部國民健康署(2020b)。《臺灣新生兒安寧緩和醫療照護參考手冊》。取自https://health99.hpa.gov.tw/material/3447
衛生福利部國民健康署(2023)。《孕婦健康手冊網站導覽》。取自https://mhb.hpa.gov.tw/phebook_1_5.html
劉宇庭(2018)。回應產檢異常: 臺灣孕婦的行動策略與終止懷孕的「選擇」。[碩士論文。國立清華大學]。臺灣博碩士論文知識加值系統。https://hdl.handle.net/11296/235448。
潘淑滿(2022)。《質性研究:理論與應用》。心理。
鄭慧如、曾冬勝、仲偉靜(2016)。〈高齡產婦面臨胎兒異常之照護經驗〉。《大仁學報》,(48),1-15。
龍亞、張勝安(製作人)、丁梓光(導演)(2023)。《去有風的地方》〈電視劇〉。中國:華策影視、瞰心晴工作室。
謝明珊(譯)(2020)。《生命的邊緣:英國療傷心理師獻給女人最強大堅定的支持,流產不該承受漠視、陷入自責,妳能學會溫柔道別,因為愛而悲傷的每一刻》(原作者:Bueno, J.)。新北:和平國際。(原著出版年:2019年)
謝郁芬、林玉蘭(2018)。〈一位因胎兒染色體異常行終止妊娠孕婦之生產照護經驗〉。《助產雜誌》,(60),22-31。https://doi.org/10.6518/TJOM.201812_(60).0003
二、英文部分
Åhman, A., Sarkadi, A., Lindgren, P., & Rubertsson, C. (2016). ‘It made you think twice’ – an interview study of women’s perception of a web-based decision aid concerning screening and diagnostic testing for fetal anomalies. BMC Pregnancy and Childbirth, 16(1). https://doi.org/10.1186/s12884-016-1057-y
Altenburger, L. E., & Soldatova, P. (2021). The Bronfenbrenner primer: A guide to develecology, Lawrence G. Shelton New York, NY: Routledge, 2019, pp. 164, $27.96 (paperback). Journal of Family Theory & Review, 13(4), 557-565. https://doi.org/10.1111/jftr.12435
Black, B. P. (2020). Stillbirth at term: grief theories for care of bereaved women and families in intrapartum settings. Journal of Midwifery & Women's Health, 65(3), 316-322. https://doi.org/10.1111/jmwh.13108
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard university press.
Bronfenbrenner, U. (1994). Ecological models of human development. International encyclopedia of education, 3(2), 37-43.
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Bronfenbrenner, U., & Morris, P. (2006). The bioecological model of human development. In R. M. Lerner & W. Damon (Eds.), Handbook of child psychology: Vol. 1. Theoretical models of human development (pp. 793– 828). John Wiley & Sons Inc.
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Chung, M. C., & Reed, J. (2017). Posttraumatic Stress Disorder Following Stillbirth: Trauma Characteristics, locus of Control, posttraumatic Cognitions. Psychiatric Quarterly, 88(2), 307-321. https://doi.org/10.1007/s11126-016-9446-y
Corr, C. A. (1999). Enhancing the concept of disenfranchised grief. OMEGA-Journal of Death and Dying, 38(1), 1-20. https://doi.org/10.2190/LD26-42A6-1EAV-3M
Crawford, M. (2020). Ecological Systems theory: Exploring the development of the theoretical framework as conceived by Bronfenbrenner. J Pub Health Issue Pract, 4(2), 170. https://doi.org/10.33790/jphip1100170
Darling, N. (2007). Ecological systems theory: The person in the center of the circles. Research in human development, 4(3-4), 203-217. https://doi.org/10.1080/15427600701663023
Dekkers, F. H. W., Go, A. T. J. I., Stapersma, L., Eggink, A. J., & Utens, E. M. W. J. (2019). Termination of pregnancy for fetal anomalies: Parents' preferences for psychosocial care. Prenatal Diagnosis, 39(8), 575-587. https://doi.org/10.1002/pd.5464
Engelhard, I. M., van den Hout, M. A., & Vlaeyen, J. W. (2003). The sense of coherence in early pregnancy and crisis support and posttraumatic stress after pregnancy loss: a prospective study. Behavioral Medicine, 29(2), 80-84. https://doi.org/10.1080/08964280309596060
Geerinck-Vercammen, C. R., & Kanhai, H. H. H. (2003). Coping with termination of pregnancy for fetal abnormality in a supportive environment. Prenatal Diagnosis, 23(7), 543-548. https://doi.org/10.1002/pd.636
Goldblatt Hyatt, E. D. (2021). Counseling women who have terminated a pregnancy due to fetal anomaly (TOPFA): The ACCEPT model. Clinical Social Work Journal, 49(1), 52-63. https://doi.org/10.1007/s10615-019-00732-0
Grussmann, M., Naderer, A., Tordy, K., Alexopoulos, J., Feichtinger, K., Gipperich, A., ... & Leithner, K. (2023). Termination of pregnancy for fetal malformation: A traumatic event? A qualitative analysis of women’s perception. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 69(1), 36-55. https://doi.org/10.13109/zptm.2023.69.1.36
Heaney, S., Galeotti, M., & Aventin, Á. (2023). Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women’s experiences of healthcare on the island of Ireland. BMC Pregnancy and Childbirth, 23(1), 529. https://doi.org/10.1186/s12884-023-05839-4
Hendriks, M. J., & Abraham, A. (2022). Perinatal loss and parental loneliness: Narratives of late termination of pregnancy. Death Studies, 46(6), 1490-1500. https://doi.org/10.1080/07481187.2021.1894511
Heazell, A. E., Siassakos, D., Blencowe, H., Burden, C., Bhutta, Z. A., Cacciatore, J., ... & Budd, J. (2016). Stillbirths: economic and psychosocial consequences. The Lancet, 387(10018), 604-616. https://doi.org/10.1016/S0140-6736(15)00836-3
Hodgson, J., Pitt, P., Metcalfe, S., Halliday, J., Menezes, M., Fisher, J., Hickerton, C., Petersen, K., & McClaren, B. (2016). Experiences of prenatal diagnosis and decision‐making about termination of pregnancy: A qualitative study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 56(6), 605-613. https://doi.org/10.1111/ajo.12501
Hsu, M. T., Tseng, Y. F., & Kuo, L. L. (2002). Transforming loss: Taiwanese women's adaptation to stillbirth. Journal of Advanced Nursing, 40(4), 387-395. https://doi.org/10.1046/j.1365-2648.2002.02386.x
Jackson, P., Power‐Walsh, S., Dennehy, R., & O’Donoghue, K. (2023). Fatal fetal anomaly: experiences of women and their partners. Prenatal Diagnosis, 43(4), 553-562. https://doi.org/10.1002/pd.6311
Kersting, A., Dorsch, M., Kreulich, C., Reutemann, M., Ohrmann, P., Baez, E., & Arolt, V. (2005). Trauma and grief 2–7 years after termination of pregnancy because of fetal anomalies – a pilot study. Journal of Psychosomatic Obstetrics & Gynecology, 26(1), 9-14. https://doi.org/10.1080/01443610400022967
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Kim, A. J. H., Servino, L., Bircher, S., Feist, C., Rdesinski, R. E., Dukhovny, S., Shaffer, B. L., & Saxton, S. N. (2022). Depression and socioeconomic stressors in expectant parents with fetal congenital anomalies. The Journal of Maternal-Fetal & Neonatal Medicine, 35(25), 8645-8651. https://doi.org/10.1080/14767058.2021.1992379
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Schechtman, K. B. , Gray, D. L. , Baty, J. D. & Rothman, S. M. (2002). Decision-making for termination of pregnancies with fetal anomalies. Obstetrics & Gynecology, 99(2), 216-222. https://doi.org/10.1016/S0029-7844(01)01673-8
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Sun, J. C., Rei, W., Chang, M. Y., & Sheu, S. J. (2018). The Experiences of Fathers Whose Spouses Are Hospitalized for Pregnancy Termination Due to Fetal Chromosome Abnormality in Taiwan. Journal of nursing research, 26(4), 297–305. https://doi.org/10.1097/jnr.0000000000000246
Sun, J. C., Rei, W., Chang, M. Y., & Sheu, S. J. (2022). Care and management of stillborn babies from the parents’ perspective: A phenomenological study. Journal of Clinical Nursing, 31(7-8), 860-868. https://doi.org/10.1111/jocn.15936
Sun, S., Sun, Y., Qian, J., Tian, Y., Wang, F., Yu, Q., & Yu, X. (2023). Parents’ experiences and need for social support after pregnancy termination for fetal anomaly: a qualitative study in China. BMJ open, 13(9), e070288. https://doi.org/10.1136/bmjopen-2022-070288
Testoni, I., Finco, N., Keisari, S., Orkibi, H., & Azoulay, B. (2021). Conflicts between women's religiosity and sense of free will in the context of elective abortion: A qualitative study in the worst period of Italy's COVID-19 crisis. Frontiers in Psychiatry, 12, 619684. https://doi.org/10.3389/fpsyt.2021.619684
Tseng, Y. F., Chen, C. H., & Wang, H. H. (2014). Taiwanese women's process of recovery from stillbirth: A qualitative descriptive study. Research in nursing & health, 37(3), 219-228. https://doi.org/10.1002/nur.21594
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dc.identifier.urihttp://tdr.lib.ntu.edu.tw/jspui/handle/123456789/99181-
dc.description.abstract因著台灣的優生學脈絡,近年來自費產檢項目廣受孕產家庭青睞,然而也帶 來妊娠過程中得知的胎兒有異常疾病。孕產家庭因而經歷告知與診斷、醫療說 明、抉擇、產後照顧等四個階段,產後的自我照顧正是研究者所感興趣的階段, 因終止妊娠意味著與寶寶道別,女性該如何處理哀傷?這個過程中可能面臨什麼 樣的挑戰?而這群女性又是如何看待這段經歷呢?因故本研究目的為以下四 點:(一)探究因胎兒異常終止妊娠女性的生命經歷、(二)探究女性因應胎兒異 常的終止妊娠事件的支持系統、(三)探究女性賦予終止妊娠事件的生命意義、 (四)探究因胎兒異常終止妊娠女性,對於現行健康照護體制服務的看法。
本研究以質性研究為研究取向,透過敘事研究方法,從受訪者的生命經驗出 發,透過敘說找到生命事件的影響與意義。以立意抽樣及滾雪球抽樣尋找 6 位受 訪者,均為懷孕第二孕期(懷孕第 17 週至第 29 週),經相關檢查發現胎兒有異 常疾病,且妊娠決策為終止妊娠者。本研究發現受訪者終止妊娠後會經歷一連串 的心理健康風暴,包括難以平復的情緒、難過、低潮,甚至是嫉妒與罪惡感,受 訪者在復元歷程中的支持大多來自配偶、家庭、職場、醫療團隊,而這些支持網 絡有著正向與負向的效果,能讓女性抒發、講述有療癒的正向效果,拒絕談論及 給予不適切回應的系統則帶給女性更大的痛苦或悲傷處理的空白,女性終究將採 取行動開始自我療癒與踏上復元之路,從自身內在的療癒開始,逐漸向近端的生 活環境出發,到遠端的文化、宗教儀式處理及行善社會與成為助人者。
本研究建議有以下五點:(一)急性醫療場域應建置終止妊娠之關懷服務團 隊、(二)醫療團隊應提供終止妊娠相關之明確資訊、(三)經歷終止妊娠應被視 為一種心理健康危機,有評估及轉介機制、(四)相關支持女性的服務應以家庭 為中心的理念提供,以及(五)台灣社會應將文化脈絡納入健康照護體系。經歷因懷有胎兒異常疾病的女性,往後的人生因著終止妊娠而轉了一個大彎,然而當 前台灣的研究仍對此議題顯少著墨,本研究透過受訪者的生命經歷與觀點,描繪 女性所經歷的困境,以及出走困境之法,希望藉此提供實務工作相關指引,使相 似經歷的女性都能在醫療場域、健康照護系統中得到合適的協助與照護。
zh_TW
dc.description.abstractDue to the context of eugenics in Taiwan, self-pay prenatal examination has become increasingly popular among pregnant families in recent years. However, this also brings with the discovery of fetal abnormalities during pregnancy. Pregnant families confront four stages during the medical process: disclosure and diagnosis, medical explanation, decision-making, and postpartum care. This study focuses on the postpartum self-care stage, as termination of pregnancy signifies a farewell to the baby. How could women cope during this process? What challenges might they encounter? How do these women perceive their experiences? Therefore, there are four research purposes: (a) explore the life experience of women who terminate pregnancy due to fetal abnormalities, (b) investigate the supposed system available to women coping with pregnancy termination due to fetal abnormalities., (c) examine how women define the meaning of their life experiences, (d) investigate women's perspectives on the healthcare system.
This qualitative research utilizes the narrative approach to explore the participants’ life experiences. The study explores the impact and significance of these life events through storytelling. The research used purposive and snowball sampling methods to select six participants, all of whom were in the second trimester of pregnancy (weeks 17 to 29) and had terminated their pregnancies after prenatal examination identified fetal abnormalities.
The findings indicate that women who terminated their pregnancies experienced a series of emotional and psychological challenges, including grief, sadness, depression, and even feelings of jealousy and guilt. The support women received during their resilient process primarily came from spouses, families, workplaces, and clinical care teams. These support networks had both positive and negative effects, positive support helped facilitate emotional expression and healing, while negative responses, such as refusing to talk about the event or offering inappropriate reactions, intensified emotional distress and left a void in emotional processing. Despite these challenges, most women eventually initiated self-healing processes, beginning with inner healing, extending to their life environment, and even reaching more distant cultural and religious practices, including acts of charity and becoming helpers for others.
This study explores five recommendations: (1) clinical care system should establish multidisciplinary care for pregnancy termination; (2) clinical care system should provide specific information regarding pregnancy termination; (3) pregnancy termination should be regarded as a psychological health crisis, with assessment and referral; (4) services supporting women should adopt a family-centered care model; and (5) the healthcare system in Taiwan should incorporate cultural contexts into its framework for healthcare system.
In conclusion, for women who terminate their pregnancies due to fetal abnormalities, the event represents a significant turning point in their lives. However, current research in Taiwan on this issue is still limited. Through the life experiences and perspectives of the participants, this study aims to depict the dilemmas these women face and the strategies they use to overcome them. The findings are intended to provide practical guidance for professionals, ensuring that women with similar experiences receive appropriate support and care within clinical and healthcare systems.
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dc.description.tableofcontents口試委員審定書 i
謝辭 ii
中文摘要 v
ABSTRACT vii
目次 x
圖次 xii
表次 xiii
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 5
第三節 名詞釋疑 11
第四節 研究目的與研究問題 12
第二章 文獻回顧 13
第一節 生態系統觀下的女性妊娠失落 13
第二節 終止妊娠女性的復元因應與困境 25
第三節 終止妊娠的悲傷相關理論 32
第三章 研究方法與設計 42
第一節 研究受訪者 43
第二節 抽樣方式 46
第三節 招募過程及研究受訪者資訊 47
第四節 資料搜集工具 48
第五節 訪談大綱 49
第六節 資料分析與程序 50
第七節 倫理議題 53
第四章 研究發現 54
第一節 遠航的故事從何開始:生命歷程文本 54
第二節 海況與風向:困境、自我認同與個體核心價值變化 69
第三節 時而漂泊時而抵抗:女性的支持系統圖像 86
第四節 乘載生命的浮力:照顧與療癒之法 102
第五節 重新掌舵:復元的圖像 113
第六節 航海日誌的插曲:悲傷之外還有什麼? 126
第五章 研究結論與建議 138
第一節 說出悲傷:於敘事中再航行一次 138
第二節 實務、政策與研究建議 148
參考資料 158
附錄一 170
附錄二 175
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dc.language.isozh_TW-
dc.subject胎兒異常zh_TW
dc.subject終止妊娠zh_TW
dc.subject敘事研究zh_TW
dc.subject生命經歷詮釋zh_TW
dc.subjecttermination of pregnancyen
dc.subjectfetal abnormalityen
dc.subjectlife experience interpretationen
dc.subjectnarrative researchen
dc.title孤帆遠航: 台灣女性因應胎兒異常疾病終止妊娠之生命經歷詮釋zh_TW
dc.titleSailing with Loneliness: The Lived Experiences of Taiwanese Women undergoing Pregnancy Termination due to Fetal Abnormalitiesen
dc.typeThesis-
dc.date.schoolyear113-2-
dc.description.degree碩士-
dc.contributor.oralexamcommittee李玉嬋;吳嘉苓zh_TW
dc.contributor.oralexamcommitteeYu-Chan Li;Chia-Ling Wuen
dc.subject.keyword胎兒異常,終止妊娠,敘事研究,生命經歷詮釋,zh_TW
dc.subject.keywordfetal abnormality,termination of pregnancy,narrative research,life experience interpretation,en
dc.relation.page175-
dc.identifier.doi10.6342/NTU202503296-
dc.rights.note同意授權(全球公開)-
dc.date.accepted2025-08-08-
dc.contributor.author-college社會科學院-
dc.contributor.author-dept社會工作學系-
dc.date.embargo-lift2025-08-22-
顯示於系所單位:社會工作學系

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