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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 張書森(SHU-SEN CHANG) | |
dc.contributor.author | Fang-Yii Chuang | en |
dc.contributor.author | 莊芳宜 | zh_TW |
dc.date.accessioned | 2021-06-08T03:34:45Z | - |
dc.date.copyright | 2019-08-26 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-08-02 | |
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Retrieved from https://dep.mohw.gov.tw/DOS/cp-2976-13831-113.html 衛生福利部統計處. (2019b). 精神醫療資源現況表. Retrieved from https://dep.mohw.gov.tw/DOS/cp-1728-2920-113.html 蕭淑貞, 陳賢佳, 葉櫻媛, 陳杏佳, & 邱淑貞. (1997). 精神病患居家自我照顧現象探討. [The Phenomena of Self Care for Psychotic Patients in Community]. 中華公共衛生雜誌, 16(6), 478-487. doi:10.6288/cjph1997-16-06-03 藍菊梅, 楊秋月, 黃瑞媛, & 蕭淑貞. (2004). The Relationship of Drug Alliance Behaviors of Schizophrenic Outpatients with the Characteristics of Key Persons and Family Function. [精神分裂症門診病患之藥物結盟行為與主要照顧者特性及家庭功能的關係]. 長庚護理, 15(1), 1-14. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/21461 | - |
dc.description.abstract | 背景與目的:讓更多的慢性精神病人出院回歸社區生活,是許多國家精神醫療發展的趨勢,而臺灣仍有相當數量的病人居住於慢性精神科病房,其住院期間長,且出院後再住院率高,病人與家屬對從慢性病房出院會有許多擔憂及不安。國內較缺乏從病人觀點闡述出院經驗的相關研究,本研究希望能從病人的角度了解在慢性病房接受復健後出院回到社區的主觀經驗,面臨了何種挑戰,以及回歸社區的有利因素。
方法:採用質性方法中的訪談研究法進行研究,針對曾住過精神科慢性病房六個月以上後出院,生活在社區的思覺失調症病人。使用架構分析法分析訪談資料,探討病人生命經驗及出院前後的相關因素。 結果:本研究共訪談了八位病人。運用包含個人、人際、社區與醫院的多層次架構來理解病人的出院經驗。在主觀經驗方面,出院後病人開始體會要能回顧學習經驗、尋求社會支持並讓自己更有彈性去磨合;與住院不同的是要學會自我管理、融入多元的人際互動;而面對自身疾病角色常是自我污名,且須面對身體的老化、退化;家庭階段的改變、跟自身社會角色的重新定位;病人在出院前往往對出院後的生活沒有想像,面對環境的變動會有不安,但在逐漸適應後開始可以有放下跟放鬆的感覺,對過日子開始有另一層的體悟,歸於平淡的康復過程就是生活。關於回歸社區的挑戰,在個人層次,病人面臨自我照顧能力不足、症狀的縈繞跟干擾、經濟負擔增加,與學習能力受限;人際層面會面臨家庭的適應與監控、復健場域人際相處與活動適應的難題、職場適應,及社區參與的侷限性;而與醫院的連結方面,會發生門診功能有限,以及慢性病房原有的社會支持因出院而結束;在面對社區多元的資源時,病人經常有不知如何連結、利用,以及不符使用資格的狀況。有利於回歸社區的因素包括:住院中的復健經驗及出院安排能協助銜接出院生活、家屬的生活管理及經濟支援、復健場域中老師的復健訓練及疾病管理與活動的協調、職場中的輔導支持、社會福利資源能提供基本生活經濟援助,而宗教是生命各階段促進社會融入的穩定力量。 結論:出院回歸社區是一種生活經驗重整與社會網絡重新建立的過程,面對在個人、人際、醫院與社區不同層次的挑戰,重要的有利因素包括在住院中的出院準備,以及家屬、復健場域、職場與社會福利的適當支援,以及宗教信仰。將來協助病人回歸社區的政策,應考慮提供某種個人化的服務,在考量病人主觀經驗與需求的情況下,因應多層次的挑戰與整合,與輔助病人串聯起多元的社區資源。 | zh_TW |
dc.description.abstract | Background and Purpose: Many countries have adopted the mental health care policy to assist more patients with chronic mental illness to be discharged from hospital and return to the community. However, a substantial number of patients with chronic mental illness are still treated in chronic psychiatric ward in Taiwan, with long duration of hospitalization and high re-hospitalization rates. Patients and family have a lot of concerns and anxieties toward discharge from chronic psychiatric ward. Nevertheless, there is a lack of local studies investigating patients’ experiences of leaving hospital and returning to the community from the patients’ perspectives. This study was aimed to understand patients’ subjective experiences about returning to the community after receiving rehabilitation treatment in the chronic psychiatric ward, with a focus on challenges faced by the patients and factors facilitating the process.
Methods: This is a qualitative study based on interviews with patients with schizophrenia who stayed in the chronic psychiatric ward for more than six months and then were discharged and lived in the community. We used framework analysis approach to analyze the data, exploring patients’ experiences and factors associated with discharge before and after the patients left hospital. Results: A total of eight patients were interviewed. A multilevel framework was developed to incorporate patients’ experiences and factors associated with post-discharge adaptation at the individual, interpersonal, community, and hospital levels. The patients’ experiences included several themes, including i) the development of the ability to reflect on past learning experiences, seek social support, and enhance personal flexibility to adapt to the post-discharge life; ii) to learn about managing own daily life and interpersonal interaction; iii) to face the challenges of self-stigma, aging, and deterioration of functions; iv) to adapt to the changes in family structure and personal social role; v) to develop the understanding of the recovery process as an integral part of life and start to enjoy a relaxing, new post-discharge life, in contrast to the inability to image post-discharge life and anxiety to any changes before leaving the chronic ward. The patients faced a number of challenges at multiple levels: i) inadequate personal care skills, the adverse effects of residual psychotic symptoms, the increased financial burden, and limited learning capacity at the individual level; ii) adaptation to family life and family’s monitoring, challenges to adapt to interpersonal interaction at the rehabilitation facilities and workplaces, and limited community participation at the interpersonal level; iii) limited support provided by the outpatient clinic follow-ups and the end of social support provided by the chronic ward after discharge at the hospital level; and iv) the challenges of dealing with various community resources to maximize their inter-connection and utilization at the community level. Factors that facilitate the process of returning to the community included: helpful rehabilitation experiences and discharge plans in the chronic ward; family’s supports on life management and finances; rehabilitation training, disease management, and activity coordination in the rehabilitation facilities; support received at the workplace; social welfare that provided basic financial supports; and religious beliefs and activities that facilitated social integration. Conclusion:Leaving hospitals and returning to the community is a process to re-organize life experiences and re-establish social network for patients with chronic mental illness, who face multiple challenges at the personal, interpersonal, hospital, and community levels. Important factors that facilitate the process include the discharge plan, adequate supports provided by the family, rehabilitation facilities, workplace, social welfare, and religion. Future policies aimed to assist the patients to return to the community should consider personalized supports that incorporate patients’ subjective experiences and needs, address challenges faced at multiple levels, and link the patients to various resources in the community. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T03:34:45Z (GMT). No. of bitstreams: 1 ntu-108-R04847026-1.pdf: 2077738 bytes, checksum: 75888d1653f71e61a9f5ad68dae6ec37 (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 論文口試委員審定書 I
謝辭 II 摘要 III ABSTRACTS V 目錄 IX 表目錄 XI 第壹章緒論 1 第一節 研究背景與動機 1 第二節 研究目的 2 第三節 實習醫院簡介: 臺北市立聯合醫院松德院區 2 第貳章文獻回顧 6 第一節 思覺失調症 6 第二節 精神科社區照護趨勢 7 第三節 精神科慢性病房長期住院狀況 8 第四節 思覺失調症病人出院面對的挑戰及需求 9 第五節 思覺失調症病人回歸社區的有利因素 11 第六節 文獻小結 12 第参章研究方法 14 第一節 研究設計 14 第二節 研究對象 16 第三節 研究工具 16 第四節 資料處理 18 第五節 研究的信效度與倫理 20 第肆章研究結果 23 第一節 人口學基本資料 23 第二節 多層次的出院經驗架構 28 第三節 出院前的經驗及準備 28 第四節 出院後生活經驗及挑戰與有利因素 42 第五節 生命經驗及體悟 89 第伍章討論 105 第一節 主要結果 105 第二節 主觀經驗 106 第三節 挑戰 111 第四節 有利因素 120 第五節 結論與建議 125 第六節 研究限制 127 參考文獻 129 附錄一 基本資料問卷 144 附錄二 精神科慢性病房出院經驗研究 訪談大綱 147 | |
dc.language.iso | zh-TW | |
dc.title | 「回歸社區」:臺北市一所醫院精神科慢性病房思覺失調症病人出院經驗之質性研究 | zh_TW |
dc.title | 'Returning to the community': a qualitative study of schizophrenia patients' experiences with discharge from chronic psychiatric ward of a hospital in Taipei city | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 官晨怡(Chen-I Kuan),邱智強(Chih-Chiang Chiu) | |
dc.subject.keyword | 社區,臺北市,精神科,慢性病房,思覺失調症,出院,質性研究, | zh_TW |
dc.subject.keyword | Community,qualitative study,schizophrenia,discharge,psychiatric,Taipei city,chronic psychiatric ward, | en |
dc.relation.page | 147 | |
dc.identifier.doi | 10.6342/NTU201902000 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2019-08-02 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
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