精神分裂症患者主要照顧者因照顧患者 引發需要之研究

Induced needs for chief caregivers of patients with schizophrenia

夏慧玲(xia hui ling)

指導教授 ： 葉玲玲

亞洲大學/健康學院/長期照護研究所/碩士(2007年)

摘要

精神分裂症病程易呈慢性化，因此患者會因罹病年數增加，其社
會功能則容易退化，照顧者在照顧患者時有相當大的壓力與負擔。照
護體系重點經常放在患者本身而忽略照顧者本身需要被照顧。因此應
將主要照顧者包含在照護過程內，提供主要照顧者各層面的需要，讓
主要照顧者照顧患者時能得到應有的支持與協助。本研究目的係探討
主要照顧者在照顧患者時所引發的需要，包含精神健康照護服務及社
會照顧服務需要。
本研究同時採質性及量性研究方法，以質性深度訪談法，瞭解主
要照顧者在照顧患者時引發的需要，並依質性研究結果發展結構性訪
談式問卷，收案的醫院包括公立精神科專科醫院、私立精神科專科醫
院及大學附設醫院，共100 位精神分裂症患者主要照顧者，用以瞭解
主要照顧者需要的精神健康照護服務及社會照顧服務、主要照顧者需
要的服務獲得狀況及其滿意度。問卷結果以卡方及二項式邏輯式廻歸
進行統計分析。
研究結果發現精神分裂症患者主要照顧者因照護患者所引發的
精神健康照護服務需要包括發病時需要的服務、緊急狀況時需要的服
務、平時需要的服務、復健服務、長期照護服務及連續性的照護服務
六大項需要。社會照顧需要包括居家服務與福利服務兩大項需要。
主要照顧者因照護患者所引發的精神健康照護服務需要依序前
三項為緊急狀況需要有固定的人或機構諮詢（99.0％）、在平時需要
有診所或醫院看門診（99.0％）、發病時需要有病床讓病人住（98.0
％）。社會照顧服務需要依序前三項為需要生活補助費（93.0％）、經
濟協助（83.0％）、機構喘息（79.0％）。主要照顧者需要且獲得的精
神健康照護服務依序前三項為平時有診所或醫院看門診（100.0％）、
發病時有病床讓病人住（98.0％）、緊急狀況有醫院可以急診（98.0
％）。主要照顧者獲得精神健康照護服務滿意度狀況，獲得滿意或部
分滿意依序前三項為發病時獲得病床能讓病人住院（97.5％）、獲得
長期照護機構（96.9％）、獲得日間病房（92.9％）。
本研究結果發現精神健康照護服務需要而未獲得及滿意度較低
的服務項目主要為社區復健服務項目及緊急醫療服務項目。這兩類項
目應是精神健康照護服務體系應優先努力的方向。在社區復健服務方
面，應加強患者由機構過渡到社區時需要的服務，同時亦需加強提供
主要照顧者在社區中照顧患者緊急狀況需要的服務，讓照顧者在患者
緊急狀況時能得到及時且適切的協助。對未來研究建議針對不同地理
區域探討精神分裂症患者主要照顧者需要狀況，了解是否因地理區域
或年齡層的不同而有差異，用以提供精神健康照護體系發展之參考。

關鍵字

精神分裂症患者、主要照顧者、需要

並列摘要

Since the course of schizophrenia tends to be chronic and the patient’s capability
in social functioning deteriorates as the years of sickness increase, the pressure and
burden imposed on the caregiver to care for the patient mount considerably over time.
The emphasis of current care system is often on the patient, not on the needs of
caregiver himself/herself. Therefore, the care process should consider and include
the chief caregiver, satisfying the needs of all aspects from the chief caregiver and
providing the support and assistance required. The objective of this study is to
investigate the needs of chief caregiver, including both mental health care services
and social care services.
This study adopts both qualitative and quantitative approaches. The qualitative
in-depth interviews were used to understand the chief caregiver’s needs resulting from
patient caring and then to develop questionnaires for advanced structural interviews.
There were 100 chief caregivers of schizophrenia patient from public/private
psychiatric hospitals and university research hospitals involved in this study to
facilitate the understanding of: the mental health care services and social care services
required by chief caregiver, the conditions of these services furnished to the caregiver,
and the levels of caregiver’s satisfaction. The questionnaire results were statistically
analyzed using chi-square and binominal logical regression.
The research findings indicated that the mental health care services required by
the chief caregiver due to caring for schizophrenia patient include six categories: the
necessary services when patients falling ill, emergency services, routine services,
rehabilitation services, long-term care services and continued care services. The
needs of social care include home care services and welfare services.
The top three categories of mental health care services that the chief caregiver
needs are the counseling by responsible people or organizations when emergency
arises (99.0%), the accessibility of clinic or hospital for routine visits (99.0%), and the
availability of hospital beds when patients falling ill (98.0%). The top three
categories of social care services are the subsistence allowance (93.0%), the
economical assistance (83.0%), and the institutional break (79.0%). The first three
categories of mental health care services that the chief caregiver needs and obtains, in
the order of significance, are the accessibility of clinic or hospital for routine visits
(100.0%), the availability of hospital beds when patients falling ill (98.0%), and the
availability of hospital for emergency care when emergency arises (98.0%). Sorted
by the level of satisfaction, the three mental health care services that are most
satisfactory or partially satisfactory to the chief caregiver who received the services
are: the availability of hospital beds when patients falling ill (97.5%), the availability
of long-term care institution (96.9%), and accessibility of daytime hospital room
(92.9%).
The study results also showed that the mental health care services needed by the
caregiver but not yet available and considered unsatisfactory are mainly the
community rehabilitation services and the emergency medical services. These two
should be the priority of efforts in improving the mental health care service system.
In community rehabilitation services, the efforts should focus on strengthening the
services needed by the patients when they are transitioned from care-providing
institution to the community, and on the services needed by the chief caregiver when
caring for patients in the community under emergency so that caregiver handling
emergency patients may receive timely and appropriate assistance. Based on the
study results, it is suggested that the future studies could investigate the needs of chief
caregiver of schizophrenia patients located in different areas so to understand any
geographical or age-based variations, which may then be used to provide
recommendations for the further development of the mental health care system.

並列關鍵字

schizophrenia、chief caregiver、need

參考文獻

行政院衛生署統計室（2006，7-9 月）．精神醫療資源現況表．2006

壓力與需求探討．八十二年行政院衛生署委託計畫。

caring for a seriously and persistently mentally ill

分裂病患主要照顧者需求及其相關因素探討．慈濟醫學，12

廖士程、胡海國、林信男（2000）．精神分裂症預後研究方法論．福