探討思覺失調症病人充權感受與健康相關生活品質之關係

An Exploration of Empowerment Perception and Health-related Quality of Life Among Patients With Schizophrenia

丘小丹(HSIAO-TAN CHIU)

指導教授 ： 黃惠滿

長榮大學/健康科學學院/護理學系(所)/碩士(2016年)

摘要

本研究目的在探討復健病房思覺失調症病人的充權感受、健康相關生活品質及其關係。採橫斷式、相關性研究設計，以方便取樣方式，調查南部某精神專科醫院102位復健病房思覺失調症病人。以三份結構式問卷收集資料：基本屬性及疾病特性問卷（含簡短精神症狀量表）、充權量表及台灣簡明版世界衛生組織生活品質問卷。結果顯示復健病房思覺失調症病人：（1）有中上程度的充權感受（平均值80.65±21.56）及健康相關生活品質（平均值51.43±15.72）。（2）年齡愈高，其「權力層面」的充權感受愈低(r= -.20, p＜.05)；精神症狀嚴重程度越低，其「合理生氣層面」的充權感受越高(r=-.198, p＜.05)。（3）男性在整體健康相關生活品質(t=2.15, p＜.05）及「環境範疇」的生活品質(t=2.21, p＜.05）滿意度上比女性高；罹病年數6-10年組在「環境範疇」的生活品質滿意度高於5年以下組(F=2.91，p＜.05)。（4）精神症狀嚴重程度越低（整體r=-.292, p＜.05、生理範疇r=-.309, p＜.01、心理範疇r=-.239, p＜.05、社會關係範疇r= -.284, p＜.01、環境範疇r= -.216, p＜.01）、越主動參與復健活動者（整體r＝.372，p＜.001、生理範疇r＝.433，p＜.001、心理範疇r＝.455，p＜.001、社會關係範疇r＝.376，p＜.001、環境範疇r＝.470，p＜.001）其整體及四範疇健康相關生活品質滿意度越高。（5）整體充權感受越高者其整體及四範疇之健康相關生活品質滿意度越高（整體r=.570, p＜.01、生理範疇 r=.527, p＜.01、心理範疇r=.605, p＜.01、社會關係範疇r=.419, p＜.01、環境範疇r=.436, p＜.01）。
精神衛生護理人員在協助思覺失調症病人復健過程中，應教導病人學習降低殘餘精神症狀對生活的影響、鼓勵於所處的環境中主動參與復健活動、合理地表達負面情緒、維護個人的權力，以促進病人的充權感受並提升健康相關之生活品質。

關鍵字

思覺失調症 ； 充權感受 ； 健康相關生活品質

並列摘要

This cross-sectional correlation study explores the relationship between perception of empowerment and health-related quality of life in schizophrenia patients. A convenience sample of 102 subjects was recruited from rehabilitation wards of a psychiatric hospital in southern Taiwan. The age ranged from 24 to 63 (M=44, SD=9.78), 74 (72.5%) were male, 89 (87.25%) were single, and 42 (41.1%) had at least 21 years of psychiatric history. Out of 18 psychiatric symptoms, the five most experienced were somatic concern, hallucinatory behavior, anxiety, conceptual disorganization, and suspiciousness.
Three instruments were used: the Brief Psychiatric Rating Scale, the Empowerment Scale (subscales: self-esteem and self-efficacy, power-powerlessness, righteous anger, and community activism and autonomy), and the Taiwanese version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) with four domains (physical health, psychological, social relationship, and environment).
Among empowerment subscales, the subjects scored highest in the domain of community autonomy and lowest in power-powerlessness. For health-related quality of life, the subjects scored highest in social relations and lowest in mental health. Age correlated negatively with power-powerlessness (r= -.20, p＜.05), with older patients having a lower perception of power. The more severe the psychiatric symptoms, the lower the righteous anger (r=-.198, p＜.05). Male patients scored higher than female patients on health-related quality of life (t=2.15, p＜.05). As expected, participation in rehabilitation activities correlated positively (r＝.372，p＜.001) and psychiatric symptoms correlated negatively with overall health-related quality of life (r=-.292, p＜.05) as well as quality of life for each individual domain. Empowerment perception correlated positively with general health-related quality of life (r=.570, p＜.01）and with each domain: physical health (r=.527, p＜.01), psychological (r=.605, p＜.01), social relations (r=.419, p＜.01), and environment (r=.436, p＜.01).
This study showed that patients who experienced fewer psychiatric symptoms, actively participated in rehabilitation activity, and perceived higher empowerment had higher health-related quality of life. It is important for mental health workers to empathize with chronic schizophrenic patients suffering from residual psychiatric symptoms and assist them in coping with their psychiatric symptoms. Mental health workers should design effective rehabilitation programs and encourage patients to participate in these programs. To promote perception of empowerment, mental health workers should remember to respect patients’ right, allow them to express negative emotions, and provide opportunities for patients to make their own decisions. Patients are also encouraged to exercise their own rights.

並列關鍵字

Schizophrenia ； empowerment ； health-related quality of life

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