反精神醫療歧視：醫病互動經驗之初探 -以南部某公立精神科專科醫院為例-

Abstract

本研究之目的在於探討精神醫療機構中醫病互動關係的型態、專業人員與精神病患對於醫療權利與回歸社會所抱持的信念型態、以及進一步瞭解在這樣的醫療氣氛之下病患所感知的醫療經驗。受限於時間與人力的緣故，採取立意取樣、以專業人員及住院病患為研究對象，並使用自填式問卷收集資料；問卷的題目採六點計分，分別是由1分代表完全不同意、到6分代表完全同意。 研究結果主要發現：一、醫療專業人員和住院精神病患在對於病患是否有權知道自己病歷內容、以及病患在醫療決策的自主權利上，看法有顯著差異，醫療專業人員組的分數低於病患組。二、教育程度較高的病患，較重視病患的醫療權利。三、醫療專業人員和住院精神病患對於醫病互動關係的看法有顯著差異，醫療專業人員組對彼此醫病互動關係的覺察較病患組正向。四、住院精神病患的醫療經驗，與醫病互動關係有顯著的正相關。五、將近六成的醫療專業人員傾向同意隔離約束有被濫用的情況。 本研究之結果呈現出醫病雙方的觀點在病患權利及醫病互動上，都存在有差異，因此結果能夠提供精神醫療單位省思，建立更為平等及良好的醫病互動關係、提升對病患權利的重視、適當的使用隔離約束治療；對於精神醫療機構之專業人員或是醫療相關科系之學生的培養上亦能夠有所提醒；也可提供公部門在政策擬定、施行與去污名化運動的推動上參考，提出更有成效的辦法和建議。

The main purpose of this study was to understand the doctor-patient relationships in a modern public psychiatric hospital in Taiwan. Another purpose was to explore the personal belief toward inpatient’s right of both psychiatric professionals and inpatients. Meanwhile, this study attempted to present the inpatients’ experience during hospitalization. The research methods involved qualitative focus groups and survey questionnaires. A questionnaire was developed specific to the study. There were 192 inpatients and 73 clinical professionals of one public psychiatric hospital in South Taiwan participated in this study. The questionnaire contained three dimensions: doctor -patient relationship, personal belief about patients’ right, and treatment-related experiences during hospitalization. The internal-consistency reliability coefficient was 0.762~0.894. The construct validity of this questionnaire was also meritorious (KMO=0.791~0.882). The data analyses were descriptive statistics, factor analysis, and regression analysis. The major finding were: (1)Staffs showed more negative belief about patient’s right then psychiatric inpatients. (2)Patients’ educational level could influence their personal belief about patients’ right. (3) Staffs perceived more positive professional-patient relationship than patients. (4) Significant correlation was found between patients’ treatment-related experiences and the doctor-patient relationship. (5) Fifty-nine percent of staffs agreed that restrain and seclusion were overused. According to this study, perceptions of the relationship between patient and psychiatric professional were different between professional group and patient group. This finding suggested that psychiatric professionals still have a lot to learn to listen what patient say and understand what are the most important concerns of patients. The results of this study could be provided for government to make effective anti-stigma policy.