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E93016
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精神障礙者復元過程與專業人員精神復健態度之初探
An Exploratory Study on the Recovery Process of Persons with Mental Disability and Attitudes towards Psychiatric Rehabilitation among Mental Health Professionals
1.宋麗玉
1.Li-yu Song
1.國立暨南國際大學社會政策與社會工作學系(所)
1.Department of Social Policy and Social Work, National Chi-Nan University
001,002,003,004
1.國立暨南國際大學社會政策與社會工作學系(所)
1.Department of Social Policy and Social Work, National Chi-Nan University
002
1.行政院國家科學委員會
1.National Science Council
A.14 計畫執行期間(起):2004-08-01
A.14 計畫執行期間(訖):2005-07-31
2004-12-202005-03-20
A.16 收到日期:2005-10-14
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精神醫療單位與社區復健機構的專業人員

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問卷一:醫院部分743份 問卷二:復健機構136份


醫院部分743
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C.2 聯絡日期:2005-10-25
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1.國立暨南國際大學社會政策與社會工作學系(所)
1.Department of Social Policy and Social Work, National Chi-Nan University
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C.7 資料公開日期:2007-08-01
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1.復元
2.精神復健
1.Psychiatric Rehabilitation
2.Recovery
 精神疾病一向被認為是容易慢性化且預後很差的疾病,處遇著重在控制與維持;然而在1980年代另一種聲音出現了,一些親身經歷復元的精神病患為文撰寫自 己的復元過程與對於醫療體系的感受和建議。另一方面,幾個長期追蹤研究顯示精神病患痊癒或是好轉的比例在46-68%之間,顛覆了過去的觀念。過去十幾 年,西方復元的相關研究對於復元過程已有一些研究發現,但是仍在持續研究當中,相關文獻提及在精神復健過程中「希望」的重要性,且復元者對於其他同儕的鼓 舞。台灣對於復元的面向未曾觸及,因此本研究以兩年的時間進行兩項相關的研究:首先尋求有復元經驗者與其重要他人,以質化方法了解其目前的復元結果、復元 過程、以及復元的促進與阻礙因素,共完成22位復元者與10位照顧者之深度訪談。第二年則完成15位對復元者進行一次訪談(共兩次)以探索期間的變化,重 要他人則只訪談一次;第二年則經由普查方式進行精神醫療機構與復健機構專業人員的精神復健態度與復健原則落實度之研究,醫院部分共寄出3479份問卷,回 收817份問卷,廢卷74份,回收率為23.48%,有效問卷共有743份;復健機構部分共寄出440份問卷、回收共143份、廢卷有7份、回收率為 32.5%。由復元者的訪談整理出有4位符合Spaniol等人(2002)所描述的「超越障礙」、6位屬「與障礙共存」、5位則為「與障礙對抗」。影響 復元的因素包括藥物有效性、精神醫療專業人員的激勵與關懷、家人的各項支持與不放棄、復元者個人正向樂觀與堅毅的人格特質、發展出有效的因應藥物副作用方 法、工作帶來自信與人際網絡、宗教的靈性啟發和關懷支持、愛的關係豐富生命與引發責任感。阻力因素主要為醫療體系方案保守和不夠多元、藥物副作用與擔心社 會歧視眼光。在精神復健態度與落實度方面,認同度與落實度差異最大的前三項是倡導社會變遷、運用環境資源、增強權能。影響醫療專業人員復健態度的主要因素 為:促進醫院處遇計畫含括精神復健、參加研討會、衛生署法規和措施支持度、醫師較OT為差;復健態度乃是復健原則之落實的最重要自變項,年齡、醫師、醫院 出院計畫對於精神復健之重視程度、閱讀相關文章書籍也是顯著變項。本研究之模式無法顯著解釋復健機構樣本在復健態度之差異;精神復健態度越正向、閱讀相關 文章書籍、擔任個案管理員則復健機構專業人員之復健原則落實度越高。根據兩年的研究發現,筆者呼籲醫師與醫院主管含括精神復健於醫院的處遇和出院計畫之 中、加強環境資源之運用、與協助維持與增強家人對精障者之支持等。

Mental illness has been regarded as tend to be chronic with poor prognosis. The traditional treatment for persons with such illness has focused on symptom control and maintenance. Nevertheless, during 1980s some consumers who have experienced recovery wrote about their recovery process and suggestions on psychiatric treatment. Previous findings indicated the importance of hope, and how people who experienced recovery could inspire their peers. In Taiwan, there is no research study on this topic to date. Thus, this research project conducted a two-year study. Firstly, the investigator in-depth interviewed 22 persons with mental illness who experienced recovery to learn about their recovery outcome, recovery process, and the facilitators and barriers of recovery. Ten caregivers were also interviewed. In the second year, 15 subjects were interviewed again. Secondly, during the second year this study implemented a survey of psychiatric professionals to understand their attitudes towards psychiatric rehabilitation. Study samples included professionals in hospitals (N=743) and in the rehabilitation agencies (N=136). Data were gathered through self-administrated questionnaire. The results showed that 4 people in recovery were in the stage of “living beyond the disability”, 6 in the stage of “living with the disability” and 5 in the stage of “struggling with the disability”. The conducive factors included drug effectiveness, the inspiring and support from medical professionals, family support, the positive perspective and hardiness of people in recovery, effective coping methods, work induced confidence and social network, spiritual inspiration and caring from religious groups, and love relationship enriching quality of life and inducing sense of responsibility. The results of analyses on survey of attitudes towards and performance on psychiatric rehabilitation principles showed that the major differences between the attitudes and performs lied on advocacy on social change, using environmental resources, and empowerment. For the hospital professional, the significant correlates of attitudes included: whether treatment plans including rehabilitation, attending related conferences, whether the mental health policy and regulations supporting rehabilitation, and doctors holding less positive attitude than OT. Attitude was the most important correlate of performance, followed by age, doctor, whether discharge plans emphasizing rehabilitation, and reading related articles and books. The model could not significantly explain the variances on attitudes among the professionals in rehabilitation agencies. Holding positive attitude towards psychiatric rehabilitation, reading related articles and books, working as a case manager, the higher the level of performance. Based on the results, the investigator calls for psychiatrics and heads of hospitals to include rehabilitation as a part of treatment and discharge plans, promoting the utilization of environmental resources, and assisting in the sustenance and advancing of family support.

D.16 完成檢誤日期:2006-07-18
D.17 預定釋出日期:2007-08-01
D.18 初次釋出日期:2007-08-01
D.19_1 最新版釋出日期:2007-08-01
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10.6141/TW-SRDA-E93016-1
https://efenci.srda.sinica.edu.tw/webview/index.jsp?object=https://efenci.srda.sinica.edu.tw:80/obj/fStudy/E93016
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