透過您的圖書館登入
IP:44.202.198.173
  • 學位論文

充權團體工作應用於精神科日間病房之成效評估

Evaluating Effectiveness of Empowerment Group Work for Day Care Patients in Psychiatric Hospital

指導教授 : 鄭麗珍

摘要


精神病人除了就醫治療外,更重要的是如何有效復健並回歸社會。日間病房是精神病人從醫院銜接社區生活之跳板,亦是我國復健資源大宗,日間病房活動如何更有復健效果而不是繼續機構化,是本研究關注的議題。然根據研究者觀察及文獻蒐集,我國日間病房病人多有因缺權而長期滯留病房的問題,因此本研究以充權為理論基礎,設計日間病房團體活動方案,探討其實施樣貌與成效。   本研究採混和研究方法,以質性研究之參與觀察法呈現病人經歷充權團體工作的歷程及現象等,以量性研究之準實驗設計分別比較參加充權團體與常規活動病人之活動表現,並以充權感受、社會功能、精神症狀嚴重度及生活品質為依變項,比較兩組的變化。實驗組收案25人,對照組35人,分別使用無母數分析、t檢定、相關分析及迴歸分析等方法瞭解病人基本資料、活動表現與依變項之間的影響和關係,研究結果如下:   質性觀察發現病人被充權後能有更多互相參與、自決、問題解決等經驗及反應,但也有資源不足、權力集中特定病友等現象。量性分析發現實驗組在活動表現、精神症狀嚴重度及生活品質的改善都顯著優於對照組,實驗組的背景變項及精神症狀也比較不會影響活動表現和復健成效。另外精神症狀對充權感受及社會功能沒有顯著影響,充權感受、社會功能及生活品質則會互相影響。   因此我們認為日間病房精神病人確實需要被充權,才能有效提升復健表現,改善生活品質,並減少現實條件及精神症狀的影響。建議健保及社會福利能更重視日間病房治療多元化所需資源,評鑑制度也能更顧及精神病人在復健過程中所需的權能感,並鼓勵社區復健機構及康復之家等復健機構也能思考充權帶給精障個案的好處進而運用之。

並列摘要


In Taiwan, more psychiatric patients stay in day care units in medical hospitals than in community rehabilitation centers due to unequally allocated reimbursement by the National Health Insurance Scheme. From design, staying in day care units is expected to be transitional so that these patients could reintegrate with the mainstream society. However, it has been reported that patients in day care units tend to prolong their stay without moving from medical hospitals to community programs. Therefore, effective rehabilitation program is called for to empower these patients so that they would successfully re-integrate into the mainstream society. This study aims to develop a empowerment group work program and to evaluate its effectiveness. A mixed method approach was used for data collecting in this study. Qualitatively, participant observation was used to record how participants would react to a given opportunity to make decisions and take actions on their own will in groups. And quantitatively, a quasi-experimental design was used to compare the outcomes performance of participants between the experimental group and the control group. Twenty-five patients from one hospital were recruited as the experimental group, and thirty-five from another hospital as control group. Four outcome measures were included as dependent variables which were empowerment perception, social functions, severity of psychiatric symptoms, and quality of life. The results indicated that participants had better performance in mutual participation, self-determination, and problem solving during e group process. However, insufficient resources for activities and uneven distributions of power within group were also observed. Quantitative analysis found that participants in the experimental group had significantly improved on their activity participation, psychiatric symptoms, and quality of life than participants in the control group. In addition, participants’ psychiatric symptoms have no significant impact on their empowerment perception and social functions. And, participants’ empowerment perception, social functions, and quality of life had interactional effect. In conclusion, this study indicates that empowering patients in day care unit could improve their psychiatric symptoms and quality of life. Policy and practice implications are included.

參考文獻


李幸容(2011)。衛生教育介入對日間留院精神病患體重管理之成效探討。中臺科技大學護理研究所碩士論文。
周明輝(2014)。精神分裂症患者的生活品質及其決定因子。成功大學公共衛生研究所碩士論文。
江一平(2009)。康復之家社區精神復健服務之研究-以某康復之家為例。暨南國際大學暨南大學社會政策與社會工作學系學位論文。
吳希文(2011)。臺灣社區復健模式對精神分裂症病患醫療利用的影響。臺灣大學臺灣大學健康政策與管理研究所學位論文。
沈詩涵(2008)。精神障礙者在就業服務中的復原與復健。臺灣大學臺灣大學社會工作學研究所學位論文。

延伸閱讀