疾病管理團體於社區精神分裂症病患成效之前驅研究

A Pilot Study of the Effect of an Illness Management Group on Patients with Schizophrenia Living in Community

藺秀慧(Hsiu‐Hui Lin) ； 郭鈺屏(Yu‐Ping Kuo) ； 林靜蘭(Esther Ching‐Lan Lin) ； 陳柏熹(Po‐See Chen) ； 陳高欽(Kao‐Ching Chen)

《護理暨健康照護研究》 10卷1期 (2014/03) Pp. 15-22

https://doi.org/10.6225/JNHR.10.1.15

摘要

背景：目前各國精神醫療模式紛紛由機構化轉移為社區導向，實證證據支持疾病管理處置可促進精神分裂症病患因應疾病症狀與管理服藥問題，進而重返與適應社區生活。目的：此前驅研究旨在瞭解社區精神分裂症病患接受疾病管理團體的成效。方法：運用類實驗單組前後測之研究設計，立意取樣選取某地區醫院日間病房之20位社區精神分裂症病患為對象，比較病患接受疾病管團體於疾病知識、服藥態度及遵囑服藥行為的成效變化。結果：社區精神分裂症病患接受疾病管理團體後，其疾病知識顯著提升，服藥態度及遵囑行為亦有進展，但未達顯著差異。團體結束後訪談病患參與團體的主觀收穫，包括－獲得知識、同儕支持、認清並接受疾病及服藥、發現原來我不是最嚴重或最奇怪的人。結論／實務應用：疾病管理團體可有效提升社區精神分裂症病患之疾病知識，但於藥物態度及遵囑服藥行為的實證成效尚待更多研究確認。建議未來可推廣疾病管理團體為社區精神衛生照護的治療模式，以協助病患疾病管理，進而促進其社區適應。

關鍵字

社區 ； 精神分裂症 ； 疾病管理團體 ； 類實驗性研究

並列摘要

Background: Community care is gradually replacing institutionalized care as the mainstream trend in healthcare worldwide. Community‐based mental healthcare care is still developing in Taiwan, and nurses are central to the success and growth of current programs. An evidence‐based intervention, the illness management group, may guide nurses to effectively assist people with schizophrenia to manage their psychotic symptoms, take their medication, and reintegrate into the community.Purpose: This pilot study examined the effect of the illness management group of patients with schizophrenia living in the community.Methods: Using a quasi‐experimental, single‐group pretest‐posttest design, a purposive sample of 20 patients with schizophrenia was recruited from a daycare setting at a local hospital. The three outcome indicators were illness knowledge, medication attitude, and adherence.Results: While all outcome indicators showed improvements, only the improvement in illness knowledge was statistically significant. Qualitative feedback from participants included knowledge gains, peer support, recognition and acceptance of the illness and taking medication, and awareness of not being the ”most serious”/”most strange”.Conclusions/Implications for Practice: This study partially supported the effect of the illness management group. Future studies should examine the impacts on the medication attitudes and adherent behaviors of this approach. Further, adjustments to the intervention content and the dosage may be incorporated to address specific contextual factors. This pilot study may help enhance the ability of nurses to provide effective community mental health services and benefit mentally ill patients in terms of illness management and community adaptation.

並列關鍵字

community ； schizophrenia ； illness management group ； quasi‐experimental research

參考文獻

林美伶、熊秉荃、林淑蓉、胡海國（2002）•精神分裂症 患者之烙印處境•慈濟醫學雜誌，14(6)，381−388。[Lin, M. L., Hsiung, P. C., Lin, S. J., & Hwu, H. G. (2002). The stigma experience of patients with schizophrenia. Tzu Chi Medical Journal, 14(6), 381−388.]

林靜蘭、熊秉荃（2005）•社區中精神分裂症病患的社會 技能訓練•台灣精神醫學，19(3)，192−203。[Lin, E. C. L., & Hsiung, P. C. (2005). Social skill training for schizophrenia patients living in the community. Taiwanese Journal of Psychiatry, 19(3), 192−203.]

林靜蘭（2007）•疾病管理模式於重返社區之精神分裂症 病患的成效研究(未發表的碩士論文)•台北市：國立 臺灣大學護理學研究所。[Lin, E. C. L. (2007). Development and effectiveness of illness management model for patients with schizophrenia to reenter community (Unpublished doctoral dissertation). National Taiwan University, Taipei city, Taiwan, ROC.]

蕭真真、林維芬、楊馥璟（2010）•「疾病管理與復元方 案」對精神障礙者復元成效之研究•中華團體心理治 療，16(2)，11−53。[Hsiao, C. C., Lin, W. F., & Yang, F. C. (2010). Effectiveness of the illness management and recovery program in promotion recovery. Chinese Group Psychotherapy, 16(2), 11−53.]

蘇玫君（2011）•精神分裂症個案之復原歷程及治療師治 療經驗之探討(未發表的碩士論文)•南投：國立暨南 國際大學輔導與諮商研究。[Su, M. C. (2011). A case study for recovery process of schizophrenia and psychotherapy experience of the counselor (Unpublished master’s thesis). National Chi Nan University, Nantou County, Taiwan, ROC.]