精神科護理師對於應用園藝治療的認知與經驗

Abstract

園藝治療是一種輔助療法的形式，對於高齡或是慢性化的個案，特別是精神障礙者，具有潛在的效益，在歐美各國應用園藝治療於照護精神障礙個案的比例相對高，國內精神障礙個案為數不少，護理師在提供照護過程中，有機會妥善運用非侵入性，且能融入住院與社區生活的園藝療法。本研究目的為調查精神科護理師對於應用園藝治療於精神障礙個案，特別是慢性精神病個案，護理師在運用園藝治療上其知識、態度、經驗之現況。 本研究以橫斷式調查研究方式，採用方便取樣(convenience sample)的方式收案，並以自擬的結構式問卷於2019年1月到4月進行資料收集，於北部某精神專科教學醫院20個病房，共收集154份護理師對於應用園藝治療的認知、態度與執行經驗等資料。 研究結果發現納入的護理師以女性居多(94.8%)，平均年齡為37.8±9.4歲，大學教育程度佔最多(68.2%)，從事護理的年資平均12.9±9.1年；專業進階層級以N2最多(46.1%)，曾經參加的繼續教育中，園藝治療時數約1.74±4.87小時，而未來願意參與園藝治療教育訓練時數以公費公假最多，約期待有5.82±12.57小時，僅有10.4%及23.4%受訪者曾運用園藝治療照護急性與慢性病人的經驗。精神科護理師認為影響園藝治療成功與否的重要因素前三項為「有足夠資源支持」、「有依個案需要設計活動及環境」及「有許多實做機會」。 護理師對於園藝治療效益認知在1到4分評估，平均2.9±0.3分，其中「生理效益」、「心理效益」、「休閒效益」、「社交效益」及「自尊自信效益」的認知分數較高；護理師對於園藝治療所持態度在1到10分中平均為6.5±1.4分，其中「我覺得園藝治療對慢性精神疾患有幫助」、「我建議廣泛運用園藝治療在慢性精神疾患的照護」、「我覺得園藝治療跟一般的心理治療有相同效益正向療效態度」及「我認為醫院應建設療癒花園並持續發展園藝治療」四項是正向態度得分最高的。護理師園藝治療的實際執行經驗在1到4分量尺中，平均為2.3±0.6分，護理師對園藝治療的效益認知越高，其對於園藝治療的正向態度也會越高，其園藝治療的執行經驗也越豐富。 對園藝治療持有正向高效益認知的護理師為進階分級較高(adjusted OR= 2.7, 95% CI: 1.244-5.861)，以及具有園藝治療執行經驗者(adjusted OR=5.228，95% CI=2.476-11.042)；與園藝治療正向態度相關有四項因素，包含高精神科年資(adjusted OR =3.465，95% CI: 1.549-7.753)、高於平均值的園藝治療教育時數(adjusted OR =2.892，95% CI: .990-8.452)、高公假公費上課意願意願(adjusted OR =3.509, 95% CI: 1.494-8.242)、較多執行園藝治療經驗(adjusted OR =4.171，95% CI: 2.004-8.681)；另外，園藝治療效益認知(adjusted OR =4.522, 95% CI: 2.130-9.599)及園藝治療正向態度(adjusted OR = 3.956, 95% CI: 1.934-8.091)正是與園藝治療執行經驗豐富有關的兩項顯著因素。 建議未來可以持續鼓勵進階護理師多參與及帶領園藝治療，亦須提供更多資源，例如公假公費，護理師將會有較高的意願接受園藝治療教育訓練，園藝治療的經驗累積，需要靠實做，但增加認知及提高正向態度亦是重要的。

Horticultural therapy is a form of adjuvant therapy that has potential benefits for elderly or patients with chronic diseases, especially those with mental disorders. The horticultural therapy is highly used in the care of people with mental disorders. There are many cases with mental disorders in Taiwan and during the process of care, the nurses have opportunities to properly use non-invasive horticultural therapies that can be integrated into hospital and community life. The purpose of this study was to investigate the current state of knowledge, attitudes and experience of psychiatric nurses in the application of horticultural treatment to mental disorders, especially in chronic psychiatric cases. This study adopted a cross-sectional study and recruited subjects by convenient sampling method. The data was collected from from January to April 2019 in 20 wards of one teaching hospital in Taipei. There were 154 psyhchiatric nurses to respond the questionnaire regarding their knowledge, attitudes and experience of applying horticultural treatment on chronic mentally ill patients. The subjects were 94.8% female, averaged 37.8±9.4 years old, 68.2% with college education, nursing work for 12.9±9.1 years. They received an averaged 1.74±4.87 hours education for horticultural therapy in the past, and were willing to have 5.82±12.57 hours continure education in the future if the institutions provide support. There were 10.4% and 23.4% ever used horticultural therapy for acute and chronic patients, respectively. The nurses considered the most importance factors affecting the sucssess of horticultural therapy were 'there are sufficient resources to support', 'the activities and the environments are designed for cases’ needs' and 'there are many opportunities to prractice'. The total scores of the nurses' knowledge of horticultural treatment were 2.9±0.3 at a 1 to 4 rating scale. The nurses thought the horticultural therapy had 'physiological benefits', 'psychological benefits', 'leisure benefits', 'social benefits' and 'self-esteem self-confidence benefits.' The nurses’ attitude toward the horticultural therapy got an averaged 6.5±1.42 in a 1 to 10 scale. The four top rating itmes were “I think horticultural treatment is helpful for chronic mental illness”, “I recommend extensive use of horticultural treatment in the care of chronic mental disorders', 'I think that horticultural treatment has the same positive effect as general psychotherapy' and 'I think hospitals should build healing gardens and continue to develop horticultural treatment.' The nurses’ experience in implementing horticultural treatment got an average of 2.3±0.6 in a 1 to 4 scale. The correlation between the above nurses' knowledge, attitudes and implementation experience of horticultural treatment, the higher the nurses' awareness of the benefits of horticultural treatment, the higher the positive attitude of horticultural treatment, and the increased experience in horticultural treatment. Factors correlated with positive cognition were advanced clinical ladder (adjusted OR= 2.7, 95% CI: 1.244-5.861), and with experience of horticultural therapy (adjusted OR=5.228，95% CI=2.476-11.042). Factors correlated with positive attitude of horticultural treatment included long history of working in psychiatric units (adjusted OR =3.465，95% CI: 1.549-7.753), higher educational hours of horticultural treatment (adjusted OR =2.892，95% CI: .990-8.452), high willingness of getting continue education on horticultural treatment (adjusted OR =3.509, 95% CI: 1.494-8.242) and more experience on horticultural treatment (adjusted OR =4.171，95% CI: 2.004-8.681). The higher horticultural treatment cognition (adjusted OR =4.522, 95% CI: 2.130-9.599) and more positive attitude about horticultural treatment (adjusted OR = 3.956, 95% CI: 1.934-8.091) are two factors significantlu associated with horticultural treatment implementation. It is suggested that to encourage psychiatric nurses to participant in horticultural treatment and trained for leading and desgining horticultural treatment therapy. The institutes are recommended to provide support for horticultural treatment, such as providing financial and material support to continue education about horticultural treatment. The experience of horticultural treatmentne needs practice and require postivie cognition and positive attitude.