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  • 學位論文

康復模式應用在慢性住院精神病人效應-中部某精神專科教學醫院

The Effects of Recovery Model Applied in Chronic Hospitalized Psychotic Patients

指導教授 : 龔建吉
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摘要


康復模式(Recovery model)係近代運用康復理念為服務導向的歐美國家主要精神醫療模式,強調協助病人發揮潛能、保持希望、重建正向自我、找出有意義生活、負責任與自我控制;緃然帶著疾病造成限制,仍可過有希望與滿足的生活。本研究旨為探討康復模式對台灣慢性住院精神病人之心理康復、生活品質與幸福感影響。採介入性因果關係之橫斷式量性研究,立意取樣方式,以中部某精神專科醫院之住院達六個月以上之39位慢性精神分裂症病人為研究對象,藉由自編康復模式方案介入前後,運用1.「精神病人心理康復階段STORI評估量表」2.「QLSP精神病人生活品質量表」3.「中國人幸福感量表CHI簡明版」結構式量表資料分析,研究結果達統計意義:1.精神病人心理康復整體進步率43.6%,主要影響第三階段準備期及第四階段重建期;2.精神病人生活品質之整體心理健康滿意度與心理特質面分數:介入前各為67.7±22.7分、7.2±1.6分,介入後提高為72.3±18.4分、7.5±1.3分,對提高生活品質主要影響為心理層面。3.中國人幸福感CHI量表分數:介入前平均分數24.7±11.9分,介入後增加為30.1±7.0分,主要改善正向情感、掌控感、身體健康、自我滿足、樂觀等構面。研究結論:1.康復模式對慢性住院精神分裂症病人具有提昇心理康復階段、提高主觀生活品質、增加幸福感等效益。2.康復模式透過團體設計方式,能強化住院慢性精神分裂症病人保持希望、建立正向自我、尋找有意義的生活及對自我負責任及管理生活之目標。建議未來擴大研究範圍與推廣精神醫療運用,增加臨床照護之希望灌注,協助克服疾病障礙限制,使更符合服務使用者需求。

並列摘要


Recovery model had been introduced to modern psychiatric care for decades, is one of the important mental health care reform in European countries, Australia and US. Recovery model emphasize on restoring patient potential, keep hope, rebuild positive self, find out meaningful life, take responsibilities and self-control, even live with the limitation of disease, they still can fulfill their life and hope. The purpose of this research is to explore the effects of recovery model in chronic hospitalized psychotic patients in Taiwan, the effects were measured by psychological recovery stage (STORI) , quality of life (QLSP) and happiness (CHI). This is a one group pretest-post test pre-experimental design. A sample of 39 chronic hospitalized psychotic patients admitted for more than 6 months of a teaching psychiatric hospital at middle Taiwan were recruited. The 3 measurements (STORI, QLSP, and CHI) were measured before and after 6 sessions recovery group therapy. There were several result reach the statistical significant: 1. Overall improvement rate of recovery stage was 43.6%,mainly increase score on 3rd stage (prepare) and 4th stage (rebuild) measured by STORI. 2. Two domains of quality of life the overall satisfaction of mental health, and ego function measured by QLSP increased from 67.7±22.7 to 72.3±18.4, and 7.2±1.6 to 7.5±1.3 respectively. 4. Sum score of CHI (happiness), was also increased from 24.7±11.9 to 30.1±7.0. Mainly improved items were positive emotion, feel of control, physical health, self satisfaction and optimism. Although this is preliminary findings in a small sample, however, the study show recovery model did have effects in improving psychological recovery stage, subjective quality of life, and happiness if chronic hospitalized psychotic patients in Taiwan. Through group therapy, patients could maintaining hope, building positive self, finding meaningful life, self control and manage life goals, better prepare for returning community living. We suggest further extend the scope of the study among different groups, promote in clinical mental health care. For health care industry, recovery model could be a value add. It enrich the scope of health care with humanity and quality, further meet the needs of service users.

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