精神科第一年住院醫師照顧住院病患所遭遇之困難和感受

Difficulties and Feelings of a First-year Psychiatric Resident in Caring for Acute Inpatients

顏正芳(Cheng-Fang Yen)

《Journal of Medical Education》 5卷1期 (2001/03) Pp. 52-60

https://doi.org/10.6145/jme.200103_5(1).0007

摘要

目的：探討精神科第一年住院醫師在照顧急性病房患者可能遭遇的臨床困難和面對困難的感受，以做為臨床指導者在提供教育訓練和協助之參考依據。方法：研究者邀請一位精神科整一年住院醫師針對照顧的急性病房個案每週記錄感到難以處理的困難問題和面對該病患時之主觀感受，並對該問題帶來之壓力程度和處理的自信程度進行評分。研究者依據文字紀錄進行內容分析，歸納出問題單元，並以中數呈現壓力和自信程度之高低。結果：在照顧急性病患時感到棘手之問題包括無法確定診斷、治療後病情無明顯改善、家屬的態度等。壓力感受程度愈高的問題，在面對時處理的自信程度相對較低。同時，在面對急性病患常出現的主觀感受包括無力感、對病患的負向情緒和對自己專業能力程度加以檢討等。結論：精神科第一年住院醫師在照顧急性患者時會面臨各種不同的臨床問題，臨床指導者宜主動了解他們的困難並適時提供協助，以利住院醫師的學習與成長。

關鍵字

精神醫學訓練 ； 臨床督導 ； 專業能力

並列摘要

The purpose of this study was to investigate the possible difficulties encountered by a first-year psychiatric resident in caring for patients admitted to the acute ward and his feelings towards these clinical problems; this information may help supervisors in their teaching. A first-year psychiatric resident was invited to record each week the difficulties encountered and subjective feelings experienced in caring for psychiatric patients admitted to the acute ward. The levels of suffering clinical difficulties and his self-confidence in coping were also rated. The records were analyzed using the method of content analysis, and the varieties and frequencies of categories are presented. The levels of suffering and self-confidence are represented by the median values. In total, 67 records from the experiences of caring for 19 patients in the acute ward were analyzed. The difficulties met by the first-year resident included uncertainty of diagnosis, physical problems, no improvement after treatment, unfamiliarity with non-pharmacological treatment models, poor compliance of patients to treatment, side effects of medications, difficulties in clarifying psychiatric symptoms, and attitude of patient families. The higher the level of suffering the resident rated, the lower was his self-confidence. The subjective feelings in caring for patients included being powerless, having negative emotional reactions to patients, and making a self-examination of his clinical skills. In conclusion, supervisors should be aware of possible difficulties encountered by first-year psychiatric residents and actively provide assistance in a timely manner to enable them to finish their clinical training smoothly. (Full text in Chinese)

並列關鍵字

training in psychiatry ； supervision ； professional competencies