編輯的話：準後疫情時代－精神衛生護理社區照護的復元與展望

Editorial Remarks: Recovery Support and Prospects of Community Care in Psychiatric and Mental Health Nursing in coming post-COVID-19 Era

陳杏佳(Shing-Chia Chen)

《精神衛生護理雜誌》 17卷3期 (2022/12) Pp. 2-5

https://doi.org/10.6847/TJPMHN.202212_17(3).01

摘要

COVID-19疫情的挑戰經歷快近三年，跌宕中似乎有緩解的跡象，各國陸續放寬防疫的標準，邁入準後疫情時代，社區照護不僅是專注於隔離或感染控制，有更多層面的基本照顧需要落實、重建與拓展。精神衛生護理從不同年齡層的個人、家庭、團體、學校、醫院、機構或社區介入，在各種疾病不同階段給予符合精神衛生需求的諮商輔導衛教、急性短期、或慢性長期的專業照護，希望能提供完整層面與完善銜接的照護服務。社區精神病人回歸社會之成效，與其疾病共處的生活獨特經歷所獲得的復元照護息息相關。本期總共收錄了一篇專欄稿、兩篇研究稿、以及兩篇個案報告。專欄稿是由中華民國精神衛生護理學會這屆新就任的理事長主筆「社區精神衛生護理師於復元導向照護之角色與實務」，內容特別介紹她執行國科會一系列專題研究計畫的成果，指出目前社區精神照護的困境及其重要性，並結合政府在精神衞生政策新趨勢與發展。首先發展由社區精神衛生護理師主導之需求導向「復元個案管理方案」，經實證研究介入後，發現對社區精神病人之需求滿足、復元、希望及信守服藥皆有顯著成效。文章中整理精神復元照護的概念，歸納社區實證復元照護模式，重新檢視社區精神衛生護理師對復元個案管理所需的知能，並建議可以作為未來認證的參考（劉，2022）。本期收錄的研究稿，皆為量性研究，對象分別是思覺失調症和情緒雙相症病人，方法分別是類實驗以及縱貫性研究設計。其一研究為「以幸福為導向之復元團體對於長期住院思覺失調症病人的幸福感成效：前驅研究」，從某精神專科醫院的慢性病房方便取樣，雖然非完全隨機分配，但採用類實驗研究原則，介入復元概念的團體治療活動，讓實驗組及對照組均接受慢性病房之常規照護，實驗組則再接受6次以幸福為導向每次60分鐘、每週一次的復元團體，結果發現主觀的幸福感受有顯著差異，顯現復元團體的內容值得推薦（黃等，2022）。另一篇為「雙相症病人主客觀睡眠品質與情緒症狀相關性之縱貫性研究」，以某醫學中心精神科病房及社區復健中心為收案場所，方便取樣情緒雙相症病人，探討睡眠與情緒症狀之間的相關性及時間變化，評量其收案當時、一個月後及三個月後，三個時間點重複測量之主客觀睡眠品質、時數及情緒症狀。變項不僅使用主觀評量，還使用穿戴式睡眠監測手環的客觀評量。結果發現睡眠品質與情緒症狀之間有密切相關性，未來可應用於預測病人疾病前兆與線索以預防發作（潘等，2022）。本期另外收錄兩篇個案報告，照護的對象分別是厭食的高中青少女和需要養護的失智老人，照護的場域分別在學校和護理之家。兩篇皆經由五大層面評估，照護方向除了在身體健康狀況，著重於個人因應，並連結家庭支持促進有效因應。一篇是「一位厭食症青少女之學校衛生護理經驗」，個案曾因進食減少、抵抗力降低引發腎臟發炎而嚴重到需住院治療，此次透過學校衛生護理師之定期會談、營養指導、家庭結盟與成員討論等護理過程，再結合醫療資源的照護，個案可以恢復體重及重新適應校園的學習生活，成功經驗可以提供學校衛生護理的參考（黃、陸，2022）。另一篇「運用懷舊治療於一位血管型失智症合併精神行為症狀個案護理經驗」，個案因家屬照顧負荷過重而轉送護理之家住院，但因有失智者常見的精神行為症狀（behavioral and psychological symptoms of dementia, BPSD），包括妄想、抑鬱等，影響照顧的互動、品質和成效，因此除了與醫師討論症狀與用藥，每天固定會談30分鐘，再協調家庭成員提供素材，聚焦於家庭成員互動與生活角色的成長，介入30－50分鐘的懷舊治療活動，每週1－2次，共進行6次後，護理問題可以獲得改善。此護理經驗運用非藥物介入的心理社會措施，搭配電腦網路媒體輔助，使護理的獨立功能更加發揮，值得未來嘗試與繼續深入探討（張、丁、林，2022）。精神衛生護理要有優良的社區照護須要兼顧廣度與深度，並能順應時勢潮流提供適當的服務。智慧醫療照護是目前的新趨勢，不管是研究資料的收集或評量，包括使用智慧型手機互動填答問題、感應式裝置紀錄健康活動等等，例如本期收錄稿件中使用穿戴式睡眠監測手環進行評量，以及提供照護服務時搭配電腦網路媒體輔助。展望未來精神衛生護理社區照護在這方面的應用時，仍須考量對象的可近性，例如城市與鄉鎮對此的差異（Knight & Winterbotham, 2020）；對象的生理與心理等因素的中介效應（mediating effects），以及其他變項例如收入等的調控效應（moderating effects）（Zhang et al., 2022）。「人口老化現象」後老年族群的精神衛生護理日益受到重視，老年與年輕族群相比，其生理與心理因素獨特且具挑戰，他們的共病情況與慢性病較多，加上老年人在憂鬱症的表現與慢性病的相關症狀有許多重疊，導致精神狀況或疾病的正確評估診斷更為複雜，其對智慧醫療的可近性相對更困難，尤其是居住於鄉鎮的老人，精神衛生護理之應用需特別留意（陳、陳，2022；Renn et al., 2021）。

並列摘要

The unpredictable COVID-19 pandemic, which has persisted for nearly 3 years, is showing signs of easing off, and governments worldwide are gradually loosening their pandemic prevention measures and ushering the world into the post-COVID-19 era. In addition to quarantine and infection control measures, community care requires implementing, recovering, and expanding basic care in several aspects. Psychiatric and mental health nursing is implemented through individual, family, group, school, hospital, institutional, and community interventions for various population groups, and it involves providing counseling, health psycho-education, and short-term or long-term professional care services at each stage of various diseases to meet the people's mental health needs; this process facilitates the provision of comprehensive and well-connected care services. The effectiveness of community residents with mental conditions to reintegrate into society is closely associated with the recovery- oriented care that they receive when they are managing their individual illness conditions. This topic is discussed in the current issue in one column, two research papers, and two case reports. The column, written by the newly appointed chairperson of the Psychiatric Mental Health Nurses Association of the Republic of China, is titled Roles and Practices of Community Psychiatric Nurses in Recovery-Oriented Care. It introduces the results attained by the principal investigator in implementing a series of special research projects hosted by the National Science and Technology Council, pointing out that the current dilemmas and their importance, and incorporate new trends in government policy on community mental health. Specifically, a need-based patient recovery-oriented program led by community mental health nurses was developed, and the results of an empirical research intervention study confirmed the program to be effective in meeting the needs of patients with mental health issues in the community and promoting their recovery, sense of hope, and commitment to medication adherence. The column describes the concept of mental recovery care, summarizes the community empirical recovery care model, and reexamines the knowledge and skills that community mental health nurses must possess to manage case patient recovery. These findings provide a reference for future implementation of community mental health nurse certification (Liu, 2022). The two research papers published in this issue are quantitative studies; the first is a quasiexperimental study on patients diagnosed with schizophrenia, and the second is a longitudinal study on those with bipolar disorder. In the quasiexperimental study, which is titled "Effects of Happiness-Oriented Recovery Group on Perceived Happiness Among Long-Stay Patients with Schizophrenia: A Pilot Study," convenience sampling was conducted in the chronic wards of a psychiatric hospital. The patients were assigned to experiment and control groups through a method that was not fully randomized. Basically, both groups of patients received routine care in the chronic wards. The experiment group also participated in a 60- min recovery group therapy session conducted once per week for a total of six sessions. The results revealed that the group therapy significantly influenced the experiment group's sense of well-being, verifying the applicability of the group therapy (Huang et al., 2022). In the longitudinal study, which is titled "The Associations of Subjective and Objective Sleep Quality and Mood Symptoms among Patients with Bipolar Disorder: A Longitudinal Study," the convenience sampling of patients with bipolar disorder was conducted in the psychiatric ward of a teaching hospital and the community rehabilitation center; the objective of this study was to explore the correlation between sleep quality and emotional symptoms and its changes over time. Specifically, the subjective and objective sleep quality, sleep hours, and emotional symptoms of the examined patients were repeatedly measured at the time of sampling and at 1 and 3 months after sampling. For measuring objective sleep quality, wearable sleep trackers were used. The results revealed that sleep quality is closely related to emotional symptoms, providing a reference for predicting the precursors of bipolar disorder in patients and preventing outbursts (Pan et al., 2022). The two case reports describe the provision of care to a high school girl who was diagnosed with anorexia and an older adult with dementia who was residing at a nursing home. Both case reports involved evaluating a patient's conditions and needs with respect to the physical, emotional, intellectual, social, and spiritual dimensions. In addition to physical health, the care procedures focused on individual coping, which was enhanced through family support. The case report on the girl with anorexia is titled "Experience as a School Nurse Caring for a Female Adolescent with Anorexia Nervosa." The girl was hospitalized because of severe kidney inflammation caused by reduced food intake and a weakened immune system. Through regular meetings (conducted by school health nurses), nutrition guidance, family alliance, member discussions, and the proper use of nursing care resources, the girl recovered her normal body weight and successfully readjusted to school life. This successful nursing experience provides a reference for school health nursing (Huang & Lu, 2022). The case report on the older adult with dementia is titled "Nursing Experience of Applying Reminiscence Therapy to Care for a Patient with Vascular Dementia and Behavioral and Psychological Symptoms." The older adult was hospitalized at a nursing home because of family care overload and exhibited psychobehavioral symptoms that are commonplace among patients with dementia (e.g., delusion and depression) and inhibited the interactivity, quality, and effectiveness of the care provided to the older adult. The older adult attended a daily 30-min meeting with the author in addition to discuss about symptoms and medication with a physician. The author also requested from the patient's family reminiscence materials centered on family interactions and life role development; these materials were used in 30-50-min reminiscence therapy sessions that were conducted 1-2 times per week for a total of 6 weeks, and they effectively mitigated the problems encountered in nursing. Nondrug psychosocial measures were applied with the support of computer and network technology, and they enhanced the effectiveness of independent nursing functions. The results of this study can be applied in clinical practice and should be further explored (Chang, Ding, & Lin, 2022). To achieve high-quality community mental health nursing care, both the breadth and depth of the services must be considered in response to current trends. Artificial intelligence in healthcare is a new trend that involves performing research data collection and evaluation, answering questions through smartphone interactions, and tracking health activities through sensory devices. This issue provides several examples of smart medical care, such as using a wearable sleep tracker and providing care services with computer and network assistance. For the provision of smart community mental health nursing care, factors related to service accessibility for application targets (e.g., the urban-rural gap) must be considered (Knight & Winterbotham, 2020). The mediating effects of patient-related physical and psychological factors must also be considered along with the moderating effects of other factors such as income (Zhang et al., 2022). Population aging is an ongoing phenomenon, and it has drawn attention to the topic of mental health care for older adults. In contrast to young adults, older adults must manage difficult physical and psychological conditions. Older adults develop various comorbidities and chronic diseases, which induce symptoms that frequently overlap with depression. This situation increases the difficulty of accurately assessing and diagnosing the mental conditions of older adults; it also impedes their access to smart medical care, particularly the older adults living in rural areas. Therefore, this phenomenon should be a key consideration during the provision of mental health nursing services (Chen & Chen, 2022; Renn et al., 2021).