長期照顧機構運用團體遊戲治療之混合方法研究

A Mixed-method Research on Group Play Therapy in Long Term Care Institution

陳嘉嘉(JIA-JIA CHEN)

指導教授 ： 蕭文高

朝陽科技大學/人文暨社會學院/社會工作系/碩士(2018年)

摘要

我國人口不斷地趨於老化，長期照顧機構替代了部份傳統家庭的照顧功能後，相關研究也顯示入住機構的長者可能因生活缺乏活動，造成認知與心智功能的衰退。許多學者表示機構不應該只有提供住宿服務，亦須兼顧老人精神層面之照顧，透過活動安排設計，適當刺激老人能力，有效改善老人功能退化。因此，本研究目的有：（一）透過行動研究之過程與反思歷程，記錄並修正團體活動之設計；（二）探討透過團體遊戲治療活動，是否能有效提升或維持老人養護機構長者認知能力及憂鬱情緒之改善；（三）藉由研究之成果，提出老人養護機構工作者設計活動之參考。
本研究共11位老人接受為期六個月的團體遊戲治療活動（共53次活動），每週2-3次，每次活動90-120分鐘，採混合方法（mixing different methods）來進行研究，量化部份採準實驗設計，以結構式問卷「簡易智能評估量表（MMSE）」及「簡式老人憂鬱量表（GDS-SF）」為資料收集工具，於研究前後及實驗階段進行測量（共測7次），使用SPSS 19.0統計軟體進行分析，以重複量數變異數分析（Repeated measured ANOVA）分析研究對象參與方案後差異性，研究過程中另以「行動研究」方式收集更深度之資料。
研究結果：（一）簡易智能狀態分數由前測平均19.91提升至後測平均21.27，在分數表上後測分數增加1.36分，達統計顯著差異（F=17.858，p＜.001）；（二）憂鬱總分由前測平均6.45降低至後測平均3.91，在分數表上後測分數降低2.54分，達統計顯著差異（F=25.054，p＜.05）。同時，在團體處遇期間，採用行動研究檢視修正團體進行工作方法，發現老人之口語表達與人際互動顯著增加，經此歷程回饋與修正可供機構參考。
根據上述研究結果，針對機構、政策、遊戲輔具設計及後續研究提出相關建議。

關鍵字

老人 ； 長期照顧機構 ； 團體遊戲治療 ； 認同功能 ； 憂鬱情緒

並列摘要

As Taiwan’s population continues to age, long-term care institutions have replaced the caring functions of some traditional families. Relevant studies have shown that the cognitive and mental functions of elderly people in institutions may deteriorate due to lack of activity in their lives. Many researchers have suggested that organizations should not only provide accommodation services but also look after the mental health of the elderly. Organizing activities designed for the elderly can provide them stimulation and effectively alleviate functional deterioration. Therefore, this study’s purpose is to: (1) document and modify the design of group activities through action research and reflection; (2) investigate whether group play therapy activities effectively enhance the cognitive skills and improve the depression emotions of elderly people in nursing homes; and (3) based on research results, propose activity designs for the reference of staff at care institutions.
In this study, 11 elderly people received six-month group-play therapy (including 53 activities) two to three times per week, with 90 to 120 minutes allocated to each activity. Research was conducted mixing different methods. Quantitative analysis was based on a quasi-experimental design, using the structured questionnaire MMSE and GDS-SF as tools for data collection. Measurements were taken before, during, and after the study (seven measurements in total). Statistical analysis was performed using SPSS 19.0. A repeated measured ANOVA analyzed the differences in participants before and after the program. Additional data was collected through “action research” during the study.
Results: (1) The MMSE score increased from the pre-test mean of 19.91 to the post-test mean of 21.27, and the post-test score in the score table increased by 1.36, indicating a statistically significant difference (F=17.858, p<.001). (2) The total depression score declined from the pre-test mean of 6.45 to a post-test mean of 3.91, and the post-test score in the score table decreased by 2.54, also indicating a statistically significant difference (F=25.054, p<.05). Additionally, during the group encounters, action research was used to examine and revise working methods within groups. It was found that the elderly people’s verbal expression and interpersonal interaction improved significantly. These feedback and revision processes serve as reference for institutions.
Based on these results, relevant recommendations are made for institutions, policies, game assistive devices design, and follow-up research.

並列關鍵字

Elders ； Long-Term Care Institution ； Group Play Therapy ； Cognitive Function ； Depression

參考文獻

巫怡美、黃英哲（2007）。團體遊戲與自我概念的關係探討。國北教大體育，2，36-40。

林瑞興（1999）。增加身體活動量對老年人的重要性。大專體育，46，87-93。

蕭秋月、林麗味、葉淑惠（2004）。運用回憶治療於機構老人照護。長期照護雜誌，8（2），133-144。

陶蕃瀛（2004）。行動研究：一種增強權能的助人工作方法。應用心理研究，23，33-48。

一、中文