社區精神分裂症患者主要照顧者需要狀況之生活品質與負荷

Quality of life and burden in needs status for caregivers with zophrenia in the community.

葉人豪(YEH JEN HAO)

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

精神分裂症由於病程長易慢性化使患者常無法自行照顧自己，需要機構或社區資源，以及主要照顧者的照顧。精神醫療體系常將照護問題放在減輕病患症狀上，忽略照顧者的需要，更遑論照顧者之生活品質與負荷。因而本研究主要想瞭解精神分裂症患者主要照顧者因照顧患者引發需要狀況之生活品質與負荷。
研究方法：採橫斷性研究，以中部某精神專科教學醫院居家精神分裂症個案主要照顧者為研究對象，共104位接受訪談。研究工具採用結構式問卷，包括病患及照顧者基本資料、照顧者照顧病人引發的需要問卷、衛生組織生活品質問卷及精神患者照顧者負荷量表，所得資料以SPSS/PC 12.0 套裝軟體進行描述性及推論性統計分析。
研究結果：主要照顧者需要精神健康照護服務項目，需要獲得幫助百分比高於80%項目，為有診所或醫院看診、固定的人或機構看診、專業人員提供電話諮詢、醫院可以急診、協助危險行為處理、連續性照護服務、醫療單位有人協助就醫，以及便利交通。主要照顧者獲得精神健康照護服務與社會照顧其不滿意百分比高於10%，為病患自我照顧訓練、社交娛樂、處理金錢、定額雇用、就業保障、家屬團體協助、經濟協助及健康檢查。
生活品質四個範疇由高至低依序為生理範疇、環境範疇、社會範疇、心理範疇。照顧者的平均總負荷量為27.38分，屬中度負荷，照顧者負荷次向度由高至低為照顧者緊張、案主依賴、家庭干擾、烙印、愧疚。對主要照顧者需要的服務項目數其綜合生活品質與總負荷量情形，在分別控制病患特質變項及照顧者變項後，進行迴歸分析，發現在控制病患變項後，主要照顧者需要健康照護與社會照顧服務項目數越多其綜合生活品質愈低與總負荷量愈高。控制照顧者變項後，主要照顧者需要社會照顧項目數越多其綜合生活品質愈高與總負荷量愈高。
結論：主要照顧者在社區復健機構需要日間病房、庇護工廠、就業輔導、康復之家、社區復健中心。在醫療機構加強病患自我照顧訓練、便利交通、協助病患危險行為處理、提供固定的人或機構讓照顧者諮詢、急診服務。在社區居家照護需要居家清潔、病患沐浴、送餐及居家喘息服務。本研究結果可提供精神醫療實務、教學、研究及減輕照顧者負荷提升社區精神病患照顧者生活品質之政策參考。
關鍵字：主要照顧者、主要照顧者需要、生活品質、照顧者負荷

關鍵字

主要照顧者 ； 主要照顧者需要 ； 生活品質 ； 照顧者負荷

並列摘要

Due to its long course and tendency of becoming chronic, patients with schizophrenia are often unable to take care of themselves, and rely on institutional or community resources, as well as main caregivers, for care. The mental health system often focuses its health care mission on alleviating patients’ symptoms, and neglects caregivers’ needs, let alone their quality of life and burden. Therefore, this study aims to understand the need for the quality of life and the burden drawn to caregivers with schizophrenia when they are taking care of the patients.
Methods: This research employed cross-sectional study, and selected caregivers with schizophrenia of home care cases from a psychiatric teaching hospital in central Taiwan as the subjects. A total of 104 caregivers accepted the interview. Structured questionnaire was used as the research tool, and included a questionnaire for the basic information of patients and caregivers, a questionnaire regarding caregivers’ needs triggered by taking care of patients, a world health organization quality of life questionnaire, and a caregiver with mental disorder patient burden scale. Data were analyzed with SPSS/PC 12.0 software for descriptive and inferential statistical analyses.
Results: Among the mental health care service items needed by caregivers, those help needed items with a percentage higher than 80%, including access to clinic or hospital for treatment, designated personnel or unit available to treat patients, professional phone consultation, hospital to accept emergency, assistance provided for managing dangerous behavior, consecutive health care service, medical assistance available from medical unit and convenient transportation. Among the mental health care service items and social care items obtained by caregivers, those items with which caregivers are most unsatisfied with a percentage higher than 10% include patients’ self-care training, social entertainment, handling money, fixed remuneration employment, employment security, family group assistance, economic assistance and health examination.
The four domains of quality of life cover the physiological domain, environmental domain, social domain, and psychological domain as listed in the sequence from high to low. The average total burden scale for caregivers reads 27.38 points, referring to a medium burden. The burden sub-domains for caregivers as listed from high to low are caregivers’ tension, case subjects’ dependence, family disturbance, stigma and guilt. Regarding the number of service items that caregivers need in terms of comprehensive quality of life and total burden points, this study conducted a regression analysis after controlling the variables of patient characteristic and caregiver respectively. The results indicated that the more number of health care and social care service items needed by caregivers, the lower their synthetic quality of life is and the higher their total burden rating is. After controlling the variables of caregiver, the results indicated that the more number of social care service items needed by caregivers, the higher their synthetic quality of life is and the higher their total burden rating is.
Conclusion: In terms of community rehab organizations, caregivers need day care center, shelter workshop, employment service, recovery home, and community rehab center. Regarding medical organizations, caregivers need enhancement in patients’ self-care training, convenient transportation, assistance in managing patients’ dangerous behavior, designated personnel or unit for consultation and emergency service. Regarding home care in the community, caregivers need services of home cleaning, bathing patients, food delivery, and home respite service. The research result could provide references to mental health systems on medical practice, teaching, research and the alleviation of caregivers’ burden to enhance caregivers’ quality of life in the community.
Keywords: caregiver, caregiver’s need, quality of life, caregiver’s burden

並列關鍵字

caregiver ； caregiver’s need ； quality of life ； caregiver’s burden

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