評值住院精神分裂症病患實施臨床路徑之照護品質

The Quality Outcomes Of The Clinical Pathways Application For The Inpatients Of Schizophrenia

彭依萍(Peng I Ping)

指導教授 ： 蔡欣玲教授/蕭妃秀助�

臺北醫學大學/護理學院/護理學研究所/碩士(2006年)

摘要

本研究目的在於分析醫學中心有執行精神分裂症臨床路徑的病房及未執行的病房與專科醫院未執行精神分裂症臨床路徑的照護過程及成果的差異，本研究採橫斷式設計，以立意取樣法，於醫學中心的2個急性病房收案54名及專科醫院急性病房30名，共84名；藉由病歷審查來評值照護過程，以Brief Psychiatric Rating Scale （BPRS）（簡短精神症狀量表）分析個案症狀變化、家屬負擔量表分析家屬自覺照護負擔情形、社會功能量表評估個案功能狀況及住院病患精神醫療照護滿意度了解個案對照護之滿意情形，結果發現：1.在護理過程方面，有實施臨床路徑的病房顯示在生理評估、心理社會評估及出院計畫方面分數明顯高於未實施臨床路徑之病房；醫學中心顯示在藥物治療方面分數高於專科醫院。2.護理成果部份：在住院天數上醫學中心與專科醫院明顯不同，以專科醫院住院天數最長。3.有實施臨床路徑對病患症狀、家屬自覺負擔及社會功能改善沒有影響。4.醫院類別對病患症狀及社會功能改善沒有影響。5. 在家屬自覺負擔方面，專科醫院較醫學中心明顯減輕。6.實施臨床路徑及醫院類別對滿意度沒有影響。因此本研究結論為實施臨床路徑在照護過程的評估及出院計畫方面較完整；本研究結果可應用於精神科急性病房精神分裂症照護指引及評值。 關鍵字：精神分裂症、臨床路徑、照護品質

關鍵字

精神分裂症病患 ； 臨床路徑 ； 照護品質

並列摘要

The purposes of this study are to explore the differences in caring process and outcome among acute inpatient units with and without implementing clinical pathway for schizophrenia at medical centre and an acute inpatient unit without implementing clinical pathway for schizophrenia at psychiatric hospital. This study is a cross-sectional design. By using the purposive sampling method, 54 patients were recruited from two inpatient units at medical centre and 30 patients were recruited from one inpatient unit at psychiatric hospital. The following scales were used: the Brief Psychiatric Rating Scale (BPRS) for monitoring the changes of symptoms, Family Burden Scale for family members’ perceived caring burden, Social Function Scale for assess patients’ functional states and Satisfaction Scale for patients’ satisfaction of caring quality. The findings were as follows: (1)In the aspect of nursing process, the scores of physical assessment, psychosocial assessment and discharge planning were higher in the unit with implementing clinical pathway for schizophrenia than the units without this intervention. (2)In the aspect of nursing outcome, there was a significant difference in the length of admission. The days of admission were longer in psychiatric hospital than in medical centre. (3)There was no significant difference in changes of symptoms and of social function. (4)The significant improvement of family members’ perceived burden was found in psychiatric hospital. (5)There was no difference of patients’ perceived satisfaction of caring quality among units with and without implementing clinical pathway for schizophrenia. The conclusions of this study were that implementing clinical pathway for schizophrenia could provide comprehensive assessment and discharge planning. The results of this study could help to develop the guideline and evaluation for implementing clinical pathway for schizophrenia. Key words:schizophrenia、clinical pathway、quality of care

並列關鍵字

schizophrenia ； clinical pathway ； quality of care

參考文獻

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