運用多元化策略降低精神科住院病人不當異性互動發生率

精神醫療機構，病人因精神混亂、躁症期急性發作性需求增加，出現具騷擾之不當異性互動行為。筆者服務於精神科病房，於處理不當異性互動過程，擔心家屬責怪與醫療糾紛影響工作士氣，故引發改善動機。經查2018～2020年病房不當異性互動發生率達44.4%，導因為病房格局狹長，男女共住不易觀察；病人精神症狀行為混亂；不當異性互動與性健康照護認知不足；缺乏團隊照護指引與相關教育課程。經介入多元化策略，訂立行為契約書、舉辦教育課程、張貼警示圖卡與宣導海報、公告不當異性互動照護指引、推動團隊共同照護網、施行性別不同分區收住等，不當異性互動發生率由44.4%下降至11.1%。臨床上面對病人的性生理需求，能運用團隊互助討論解決方式，自信提供性健康照護。

關鍵字

多元化策略；精神科住院病人；異性互動

並列摘要

In psychiatric hospitals, patients may exhibit harassing behavior and inappropriate heterosexual interactions due to increased sexual needs during acute episodes of mental confusion or mania. Employee morale can be impacted by concerns about medical disputes or conflicts with patients' families when handling these inappropriate interactions. Investigations revealed that the incidence of inappropriate heterosexual interactions in the ward from 2018 to 2020 was 44.4%. Contributing factors included the narrow and long layout of the ward, making it difficult to observe patients' disorganized behavior due to psychiatric symptoms, insufficient sexual health education, and the lack of related guidelines and education courses. To address these issues, we implemented multiple strategies: 1. providing behavior therapy; 2. holding education courses; 3. posting warning signs and promotional posters; 4. announcing guidelines regarding inappropriate heterosexual interactions, 5. promoting shared-care networks; 6. segregating patients by gender. As a result, the incidence of inappropriate heterosexual interactions decreased from 44.4% to 11.1%. When addressing the sexual needs of inpatients, sexual health education should be provided through group problem-solving discussions.