思覺失調症患者主要照顧者家庭功能與照顧負荷相關因素之探討

中文摘要思覺失調症是病程慢性化及社會功能退化之疾病，除患者本身，亦同時影響照顧者情緒及承受極大負荷，本研究旨探討思覺失調症患者之主要照顧者家庭功能與照顧負荷相關影響。本研究採立意抽樣法，以結構式問卷，選擇中部某精神專科醫院門診、日間居家之思覺失調症患者主要照顧者為研究對象，發放問卷190份，扣除填寫不完全29份，實得有效問卷161份，回收率84.73%，回收資料以SPSS17.0進行描述性統計，分析基本資料之類別變項及連續變相分佈情形，以推論性統計皮爾森積差相關及複迴歸分析進行家庭功能與照顧負荷之相關性及影響，並分析結果與研究假設逐一驗證比較。研究結果發現：研究對象對於家庭功能感受平均得分為95.08，由高至低依序為角色功能、健康照顧功能與規範功能，其餘由高至低依序為情緒功、獨立依賴功能、問題解決功能、權力決策功能、溝通功能、教養功能及夫妻功能。對於照顧負荷平均得分為29.34，屬中度負荷。各次量表由高至低依序為照顧者緊張感、案主依賴、愧疚、家庭干擾、烙印。家庭功能與照顧負荷達顯著負相關，各次量表由高至低依序為「情緒功能」相「問題解決功能」、「夫妻功能」、「權力決策功能」、「溝通功能」、「健康照顧功能」、「獨立依賴功能」、「教養功能」、「角色功能」、「規範功能」。換言之，照顧者整體家庭功能感受越好則整體照顧負荷感受越輕。控制家庭功能變項進行迴歸分析，「問題解決功能」、「情緒功能」、「角色功能」、「夫妻功能」、「獨立依賴功能」，可預測照顧負荷總變異量的37.0%其中以「夫妻功能」最具預測力。表示此五項可有效預測精神分裂症患者主要照顧者整體照顧負荷感受。本研究結果可在未來照護過程中提供醫療照護人員擬定適當的措施，需建立有尊嚴照護制度，患者家庭亦需社會大眾、社會福利、醫療與教育等單位及政策規劃者深層同理與關懷，妥善規劃家庭支持系統並提供整合性安置。關鍵字: 思覺失調症、家庭功能、照顧負荷

關鍵字

照顧負荷；家庭功能；思覺失調症

並列摘要

Abstract Research Purpose: The purpose of this study is to explore the influences of family coping behaviors, psychological distress, social support, and patient behavioral problems on family functioning in families providing care for a member with schizophrenia. Family function and caregiver burden theory provided the theoretical framework for this study. Research Method: The study was set in the psychiatric outpatient department、day care ward、home home community of a mental hospital in the central Taiwan and data was collected by means of quantitative research. A convenience sample of 190 families providing care for a family member with schizophrenia; the valid questionnaires were 84.73%. The data was gathered through valid and reliable questionnaires, being analyzed by SPSS software using descriptive statistics, Pearson correlation coefficient, t-test, analysis of variance (ANOVA) and linear regression analysis (α=0.05). Among of group differences were analyzed using unpaired t test for comparison of caregiver burden theory and family function means and subscale scores. Pearson’s correlation coefficient was used to find the direction and magnitude of association between the various dimensions (subscales) of caregiver burden theory and family function from family. Research Results: Subjects’ average score for family functional feeling was 95.08. From high to low, the “roles function” and “health care function and normative function” were ranked in sequence. The others were from high-low, “emotional function”, “independent dependent function”, “problem solving function”, “power decision function”, “communication function”, “education function”, and “couple function”. The average score for the caregiver burden is 29.34, which is a moderate load. There was a significant negative correlation between family function and caregiver burden. In other words, the better the overall family function, the lighter the overall caregiver burden. The family functional variables for regression analysis, “problem solving function”, “emotional function”, “character function”, “couple function” and “independence dependent function” can predict 37.0% of the total variation in the caregiver burden. Findings indicate that the five items can effectively predict the overall caregiver burden perception of the primary caregiver in patients with schizophrenia. This knowledge may be useful for mental health nurses in assessing families and developing nursing interventions. Research Conclusions: The family is an important factor which affects the patient’s mental well-being and outcome. However, the family may itself be burdened by the enormous hardships created by the schizophrenic patient. A comprehensive and empathic understanding of the family members on various dimensions would throw more light in determining the behavioral patterns existing in the family and development of newer treatment techniques. Providing better social support and understanding the family functioning will result in strengthening the family as a unit, so as to provide better care to the patient. Key words: Schizophrenia, Family Function, Care Burden