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  • 學位論文

住院慢性精神病患院內工作訓練對工作自我效能與生活品質之成效探討

A Study on the effect of in-hospital work training for Chronic Mental Illness inpatients work–related self efficacy and quality of life

指導教授 : 郭乃文

摘要


近年來醫護人員運用生活品質來評估醫療與照護成效,以「病人為中心」之治療目標逐漸受重視而被引用,以往從狹隘的生物性觀點來看健康的問題已逐漸被宏觀的社會環境因素觀點取代,因此醫療照顧不能只看患者的病,還需要考慮患者整個生活品質。研究顯示對於住院中慢性精神病患給予工作訓練的復健治療,不但能減少病患退縮行為且增進人際關係的互動,在焦慮情緒、社交生活退縮、異常的思考行為、遲滯的動作反應等症狀,皆有消失或減輕的現象,而病患對於自我生活安排亦變得更主動積極、有目標。患者有固定的復健工作,且有固定收入,比沒有工作及從事無給薪復健方案者,較容易對自己有更正向的看法,不但有助於精神症狀之轉移,也提升患者生活品質,工作有助於病患規律的生活和學習時間安排,並提昇其自信與尊嚴。 本研究目的在探討住院慢性精神病患院內工作訓練對工作自我效能與生活品質的成效,以及兩者之相關性並找出重要預測因子。採橫斷式研究,立意取樣法於北部某精神科專科醫院慢性病房, 對150位慢性精神病患收案為研究對象,有工作訓練者61位,無工作訓練89者位。研究工具為結構式問卷,內容包括三部分:一、個人基本資料(含基本屬性、疾病因素與工作經驗);二、工作自我效能量表;三、生活品質量表。 資料分析採描述性統計、卡方檢定、皮爾遜積差相關分析、t 檢定、單因子變異數分析。 研究結果顯示:研究對象之工作自我效能平均得分173.66分(總分270分)。工作自我效能四因素中得分最高為因素二「實際面臨工作及保護自我權益的信心」、其次是「因素四求職技巧的信心」、因素一「職業準備技巧的信心」、最低是因素三「自我了解與社交技巧的信心」。有無院內工作訓練之慢性精神病患其工作自我效能總分及因素一、二、三皆有顯著差異(p=.001),只有因素四無顯著差異。 生活品質平均得分49.51分(總分80分),屬中等程度滿意,生活品質四範疇中最高為「心理範疇」平均得分12.60分、其次是「環境範疇」平均得分12.46分、「生理範疇」平均得分12.42分、最低為「社會關係範疇」平均得分12.04分。有無院內工作訓練之慢性精神病患其生活品質在心理範疇有顯著差異(p=.045)。 以Pearson積差相關分析來檢視住院慢性精神病患「工作自我效能量表」與「生活品質量表」總分及各範疇間的相關性。結果顯示皆呈現「低度相關」至「中度相關」之正相關。 根據以上的研究結果,精神醫療人員應適時對住院慢性精神病患提供有效的量表,了解病患在復健過程的需要,據此擬定適合病患的復健與照護計畫,提高其工作自我效能及生活品質,進一步讓病患能有機會離開醫院回歸社區,更有能力持續工作復健及樂在生活。

並列摘要


In recent years, medical professionals started to evaluate the effectiveness of care by measure the quality of living and patient-centered care became important and vital in health care. Health is no longer about physiological point of view, but also includes the entire quality of life. Studies showed that providing job training and recovery session to chronic psychiatry patient do not only increase socialization, but also patients became very proactive and goal-oriented when arranging their personal daily activities. Furthermore, a job provides them a stable income which allow them to have a more positive view compare to those who do not have a job. This aids in distraction of psychological symptoms and also improve quality of life. This purpose of this study was to explore the effectiveness of in-hospital job training on self-efficiency and quality of life among chronic psychiatry patient and also their predicting factor. The study design was cross-sectional and used purposive sampling among chronic patients from psychiatry ward in Northern Taiwan. The sample size was 150 patients with 61 who has job training and 89 does not. The material of this study was structured questionnaires included 3 components, personal characteristics, self-efficiency score, and quality of life. The data analysis used descriptive analysis, chi test, Pearson correlation coefficient, T-test and ANOVA. The average of the self-efficiency score was 173.66 out of 270 and there was a significant different between those who received in-hospital job training and those who did not (p = 0.001). For quality of life, the average score was 49.51 out of 80. There was a significant different between those who received in-hospital job training and those who did not (p = 0.045). Using Pearson correlation coefficient to analyze the correlation between self-efficiency and quality of life, it showed positively modestly correlated and moderately correlated. According to the finding of this study, the medical provider should analyze patient using effective tools to understand the needs in recovery process. This can help create recovery and care plan to induce job effectiveness and quality of life of the patients. Furthermore, This also provide an opportunity for patient to go back to the society.

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