園藝活動對療養院慢性精神病患之影響

Abstract

本研究係以量化與質性觀察方式探討園藝活動對療養院慢性精神病患生心理之影響，以及園藝經驗與活動時間長短是否會影響病患之活動表現及效果。共進行兩次為期三個月的試驗，第一次試驗有18位病患參與，實驗組與對照組各9位；第二次試驗則有29位參與，實驗組與對照組分別為15與14位，兩組研究對象在人口學資料沒有顯著差異。兩次試驗之病患疾病診斷型多為精神分裂症。第一次試驗實驗組參與每週一次、每次1.5小時之園藝活動，第二次試驗活動頻率增加為每週二次；對照組仍進行療養院安排之例行活動。活動內容包含植物認識、栽種繁殖、採收及成品運用與手工藝等項目。評估方面，兩組成員均於團體前後以自評方式，接受注意力測驗、手功能測驗、園藝知識測驗與偏好與滿意度調查表測試，而實驗組還會進行職能治療綜合評估表與園藝活動影響量表之評估，前者前後測皆由成員之主治職能治療師評估，後者則於活動前測由個案之主治護士與主治職能治療師評估，團體結束後測由活動執行者與活動助手對個案表現進行評估。 園藝活動對慢性精神病患生理上的影響，由量化結果顯示，對病患工作技巧的培養與體力訓練有幫助，但短期並未增進手功能；心理方面，園藝活動對個案的情感表現、心情、興趣、責任感、認知功能上的注意力與記憶力等都有顯著助益，並在短時間即能觀察到效果，以注意力為例，園藝活動組的前後測平均得分分別為45.78及52.89，對照組的前後測平均得分分別為53.11及47.66，顯示園藝組的得分有顯著進步，而對照組卻有顯著退步的現象；社交互動方面，參加園藝活動的個案增加在團體中的適應能力、人際互動、溝通技巧及言語表達能力，以社區性�適應能力為例，園藝活動組的前後測平均得分分別為3.34及3.77，顯示園藝組的得分有極顯著的進步。另外，在園藝經驗與活動時間的影響上，無園藝經驗組在園藝知識的學習與一般操作性活動上的表現改善較多，而園藝經驗組則在團體適應、對壓力挫折的忍耐度與對命令的反應上表現較好。參加園藝活動時間的長短並未影響個案園藝知識的學習，但個案在社區性�適應能力、工作技能、服從性與紀律性�組織性的進步，則以參與活動時間越長越易觀察到。質性研究中透過課堂觀察，可注意到個案在園藝活動期間生心理正向的改變，與護理人員及職能治療師的訪談結果，能進一步得到確認。以上結果顯示療養院慢性精神病患若身處於自然環境，透過對植物的照顧及收穫物的利用，可以改善生心理狀態。

This study was conducted to evaluate the beneficial effects of horticultural therapy（HT）activities and the influence of horticultural experiences and the duration of activities on patients with chronic mental illness in a public psychiatric center. The study was conducted twice each covering a period of three months at Bali, Taipei. The patient’s change in both physical and psychological are observed along with questionnaire and measurable tests. In the first study, 18 participants were divided into two groups as the activity group (n=9) and control group (n=9). In the second study, 29 participants were divided into two groups as the activity group (n=15) and control group (n=14). Demographic data for both groups showed no significant different and most diagnoses of the participants were schizophrenia. The activity group attended a 1.5 hr horticultural program once a week in first study and twice a week program in second study. The control group participated in the otherwise scheduled routine activities at the center. The types of the horticultural activities included knowing plants, planting and propagation, harvest and products use, and craft work. For evaluation, four instruments, including attention test, hand dexterity, horticultural knowledge test and preference and satisfaction questionnaire were used as self-evaluation to both activity and control groups right before and at the end of HT programs. The activity group was also evaluated by a comprehensive occupational therapy examination and a rating scale for measuring the effects of horticultural therapy, conducted by the occupational therapists in charge for the former test both before and after the activity. The latter test was carried out by the nursing staffs and occupational therapists in charge before the activity and by activity leader and assistant at the end of programs. The activity group showed improvement in work skills and physical strength but not in hand dexterity during the period of the program. On the other hand, significant improvement was obtained in patients’ affect, mood, interest, the sense of responsibility, attention and memory in cognitive function during the same period In attention test, the average scores of horticultural group increased from 45.78 before to 52.89 after the activity, and the corresponding values of control group decreased from 53.11 to 47.66. In social interaction, the patients’ community, organizational skills, communication skills and verbal expressiveness showed significant improvement for the activity group. In community skills, the average scores of horticultural group increased from 3.34 to 3.77 after the activity. Moreover, patients with no previous gardening experience showed much progress in their horticultural knowledge and work behaviors which patients with previous gardening experience performed better in group adaptation, coping with the pressures and order. The program duration did not affect the participants’ learning of horticultural knowledge. However, the longer the program extends, the more obvious benefits in community skills, basic work skills, dealing with authority and organizational skills would be observed. Furthermore, the positive impacts of horticultural program monitored through observation on site and with the nursing staffs and occupational therapists were confirmed. Therefore, it could be concluded that patients with chronic mental illness in a psychiatric center can benefit and positively influence their own health state from gardening program by contact with nature, working with soil, caring plants, watching their growth and harvest them for use.