思覺失調症病人暴力行為對其主要照顧者之習得智謀、照顧負荷及照顧需求相關之探討

A Study of Schizophrenia Patients’ Violent Behaviors to Primary Caregivers’ Learned Resourcefulness, Care Burden, and Needs

林惠珍(Hui-Zhen Lin)

指導教授 ： 陳芬如

義守大學/醫學院/醫務管理學系/碩士(2017年)

摘要

背景：思覺失調症是病程慢性化及社會功能退化之疾病，又以暴力行為讓主要照顧者最感困擾，除病人本身受影響，亦同時影響照顧者情緒及承受極大負荷，干擾整體家庭及經濟，過去研究多針對照顧者照顧負荷之變項探討，希望再藉由有無暴力之主要照顧者自身因應之習得智謀及其照顧需求進行相關性研究。
目的：探討與比較有無暴力行為思覺失調症病人之主要照顧者的習得智謀、照顧負荷及照顧需求相關之影響與其關係。
方法：採橫斷式相關性研究，立意取樣，選取南部某醫學中心精神科急性病房，診斷思覺失調症病人有無暴力行為之主要照顧者各30位，共60名為研究對象。以結構式問卷訪談收集資料，工具包括：習得智謀量表、照顧者負荷量表及照顧需求量表。以描述性統計、獨立樣本t檢定、卡方檢定及皮爾森相關進行統計分析。
結果：思覺失調症病人有無暴力行為對其主要照顧者在照顧負荷上無差異性，暴力行為病人主要照顧者負荷45.10±10.11分及無暴力行為主要照顧者負荷46.40±8.55分，皆屬重度負荷，顯示家庭中有生病家人皆有相當負荷；而暴力行為之主要照顧者在習得智謀之轉化性自我控制(p=.026)及再建構式自我控制(p=.043)有顯著差異；在照顧需求之資訊需求(p=.023)、實質需求(p=.038)與總需求(p=.028)亦有顯著差異；進行相關性檢定，總習得智謀與總需求呈正相關（r＝0.326,p＜.001），自覺信念自我效能與家庭干擾（r=0.259,p=.045）呈正相關。
結論：思覺失調症病人其主要照顧者承擔病人長期治療與生活事件壓力等多重負荷，透過習得智謀之轉化性自我控制調節內在自我壓力，與再建構式自我控制達到自我設定目標之有效因應；並顯示照顧者運用習得智謀能力因應壓力者，有資訊、實質、與總照顧需求。因此醫療人員可藉由每一次與主要照顧者互動時，提供照顧者適切照顧需求，尤其是資訊資源以供照顧者內在學習調控處理照顧病人的負荷，有助提昇病人家庭整體照護品質。

關鍵字

思覺失調症 ； 暴力行為 ； 習得智謀 ； 照顧負荷 ； 照護需求

並列摘要

Background: Schizophrenia is a mental disorder featuring chronic progressionand devolution of social function, what made the primary caregivers feel most difficult was violent behaviors, it affected not only patients themselves but also the mood and heavy burden of caregivers to disturb the whole family and their financial status. Previous studies have examined the variable of caregiver burden of caregivers, we aimed to conduct the study of relationship between violent behaviors and learned resourcefulness as well as care needs of primary caregivers.
Objectives: The purpose of this study was to explore and compare violent behaviors of patients with Schizophrenia to primary caregivers’ learned resourcefulness, care burden, and needs.
Methods:A cross-sectional study was conducted via purposive sampling survey covering a total of 60 subjects, the researcher chose 30 primary caregivers each for schizophrenic patients who had violent behaviors or not at an Acute Psychiatric Ward of a medical center in southern Taiwan.A structured questionnaire was used to collect data with the following tools: Learned Resourcefulness Scale, Caregiver Burden Scale, and Care Needs Scale. All the data were analyzed bydescriptive statistics, Independent-Sample T Test, Chi-square test, and Pearson product moment correlation.
Results: There was no difference on the caregiver burden of primary caregivers whether the schizophrenic patients who hadviolent behaviors or not, the mean for primary caregivers’ burdens for patients with violent behaviors was 45.10±10.11 while the mean for patients without violent behaviors was 46.40±8.55, both heavy burden level, it indicated that family members undertaken a certain of burdens when there was patients at a family; there was a significant difference on redresssive self-control (p=.026) and reformative self-control (p=.043) of learned resourcefulness for the primary caregivers of patients had violent behaviors; moreover, there was a significant difference on Information Need (p=.023), Real Need. (p=.038), and Total Need. (p=.028) of care needs;and to exam the relevance to conclude that total learned resourcefulnesswas positively correlated to total need (r＝0.326,p＜.001), perceived belief and self-efficacywas positively correlated to family interfering (r=0.259,p=.045).
Conclusions: The primary caregivers of schizophrenic patients who undertake multiple burden due to the long-term care and life event pressures of patients shall regulate the pressure of inner-self via redresssive self-control of learned resourcefulness and reach the self-setting goal via reformative self-control of learned resourcefulness; and it showed that caregivers who utilize learned resourcefulness to cope with the pressure had information need, real need, and total needs. Therefore, the medical personnel can offer the adequate care needs to the caregivers whenever interacting with primary caregivers, especially, the resources of information to caregivers to learn to regulate the burden when caring patients to enhance the overall nursing caring quality of the family of patients.

並列關鍵字

Schizophrenia ； Violent Behaviors ； Learned Resourcefulness ； Caregiver Burden ； Care Needs

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