影響庇護工作坊之精神分裂症患者工作行為的因素

The Factors that Affect the Work Behaviors of Clients with Schizophrenia in Sheltered Workshops

10.30074/FJMH.201306_26(2).0001

林淑鈴(Shu-Ling Lin)；吳亭芳(Ting-Fang Wu)；潘璦琬(Ay-Woan Pan)；林幸台(Hsin-Tai Lin)；林本堂(Pen-Tang Lin)；呂明憲(Ming-Hsien Lu)

庇護性工作坊 ； 自我效能 ； 疾病管理 ； 病前工作史 ； 工作行為 ； sheltered workshop ； self-efficacy ； illness management ； employment history ； work behavior

中華心理衛生學刊

26卷2期（2013 / 06 / 01）

189 - 214

繁體中文

研究目的：本研究之目的在於探討參與庇護性工作坊的精神分裂症患者，其病前工作史、教育程度、自我效能以及疾病管理對工作行為的影響。研究方法：本研究訪談131位目前參與庇護性工作訓練的精神分裂症患者，由研究參與者填寫「自我效能量表」來評量其自我效能，並以「精神疾病症狀知識量表」、及「藥物態度量表」兩份問卷，評量研究參與者之疾病管理。此外，研究者以「工作行為評量表」評估研究參與者參與庇護性工作坊的工作行為。資料收集後，以SPSS12.0統計軟體加以分析，以描述性統計、皮爾森積差相關和逐步複迴歸等統計方式，進行資料分析。研究結果：參與庇護性工作坊的精神分裂症患者：(一)自我效能以及疾病管理中的藥物態度，兩者皆與工作行為達顯著相關。(二)自我效能、病前工作史，以及藥物態度等變項，可以有效解釋精神分裂症患者的工作行為，依序為自我效能、病前工作史，以及藥物使用態度，解釋之總變異量達23.7%。研究結論：職業重建人員，在提供精神分裂症患者就業服務時，應增強案主職前社交與技能訓練的自我效能，且持續提供疾病管理與復元的概念，使職業輔導的服務更具全面性。

Purpose: The purpose of this study was to explore the effects of self-efficacy, illness management, education, and employment history on the work behaviors of clients with schizophrenia in sheltered workshops. Methods: A total of 131 clients with schizophrenia participated in this study. Participants completed 3 self-report questionnaires: the Self- Efficacy Scale (SES), the Knowledge for Illness Scale (KIS), and the Drug Attitude Inventory (DAI). In addition, the Work Behavior Inventory (WBI) was administrated to evaluate participants' work behaviors. Work behavior scores were obtained via observing clients and interviewing their therapists. Data were analyzed via descriptive statistics, Pearson correlation, and stepwise multiple regression analysis. Results: The analysis indicated that self-efficacy, employment history, and attitude toward drug treatment were significant predictors of the work behaviors of clients with schizophrenia in sheltered workshops. Conclusions: Vocational rehabilitation practitioners should utilize the concept of self-efficacy in prevocational programs to improve schizophrenic clients' confidence in their social skills and work behaviors. In addition, group therapy can be applied to teach clients illness management skills to enhance drug compliance and recovery concepts.

1. 宋麗玉(2005)。精神障礙者之復健與復元─一個積極正向的觀點。中華心理衛生學刊，4(1)，1-29。
   連結：
2. 行政院勞工委員會(2009)：〈98年身心障礙者勞動狀況調查〉。2011年5月5日，取自http://www.evta.gov.tw/content/content.asp?mfunc_id=14&func_id=61&type_id=0&cata_id=0&id=20334&mcata_id=0&SearchDataValue=。
3. 張自強(2003)：〈精神障礙者職業重建及推介就業之流程〉。《精神障礙者就業服務工作手冊》。台北：行政院勞工委員會職業訓練局。
4. 周美華(2003)：〈適宜推介就業之精神障礙者特徵與條件〉。《精神障礙者就業服務工作手冊》。台北：行政院勞工委員會職業訓練局。
5. 徐淑婷(2007)：〈精神障礙者職評應注意事項與範例說明〉。《身心障礙者職業輔導評量工作手冊》。台北：行政院勞工委員會職業訓練局。
6. 內政部統計處(2012)：〈100年身心障礙者福利統計〉。2012年05月25日，取自http://www.moi.gov.tw/stat/news_content.aspx?sn=3591。
7. American Psychiatric Association、孔繁鐘編譯、孔繁錦編譯(2007)。精神疾病診斷準則手冊DSM-IV-TR。台北:合記。
8. Andresen, R.,Oades, L.,Caputi, P.(2003).The experience of recovery from schizophrenia: Towards an empirically validated stage model.Australian and New Zealand Journal of Psychiatry,37,586-594.
9. Anthony, W. A.(1994).Characteristics of people with psychiatric disabilities that are predictive of entry into the rehabilitation process and successful employment outcomes.Psychosocial Rehabilitation Journal,17(3),3-14.
10. Anthony, W. A.,Jansen, M. A.(1984).Predicting the vocational capacity of the chronically mentally ill.American Psychologist,39(5),537-544.
11. Bandura, A.(1997).Self-efficacy: The exercise of control.New York:W.H. Freeman.
12. Becker, D. R.,Drake, R. E.,Bond, G. R.,Xie, H.,Dain, B. J.,Harrison, K.(1998).Job terminations among persons with severe mental illness participating in supported employment.Community Mental Health Journal,34,71-82.
13. Boardman, J.(2003).Work, employment and psychiatric disability.Advances in Psychiatric Treatment,9,327-334.
14. Bond, G. R.,Friedmeyer, M. H.(1987).Predictive validity of situational assessment at a psychiatric rehabilitation center.Rehabilitation Psychology,32(2),99-112.
15. Bond, G. R.,Meyer, P. S.(1999).The role of medications in the employment of people with schizophrenia.Journal of Rehabilitation,65(4),9-16.
16. Bryson, G.,Bell, M. D.(1997).The work behavior inventory: A scale for the assessment of work behavior for people with severe mental illness.Psychiatry Rehabilitation Journal,20(4),47-57.
17. Coleman, M. T.,Newton, K. S.(2005).Supporting self management in patient with chronic illness.American Family Physician,72(8),1503-1510.
18. Cook, J. A.,Razzano, L.(2000).Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice.Schizophrenia Bulletin,26(1),87-103.
19. Evans, J. D.,Bond, G. R.,Meyer, P. S.,Kim, H. W.,Lysaker, P. H.,Gibson, P. J.,Tunis, S.(2004).Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia.Schizophrenia Research,70,331-342.
20. Fabian, E.(2000).Social cognitive theory of career and individuals with serious mental health disorders: Implications for psychiatric rehabilitation programs.Psychiatric Rehabilitation Journal,23,262-270.
21. Gioia, G.(2005).Career Development in Schizophrenia: A heuristic framework.Community Mental Health Journal,41(3),307-325.
22. Gold, J. M.,Goldberg, R. W.,McNary, S. W.,Dixon, L. B.,Lehman, A. F.(2002).Cognitive correlates of job tenure among patients with severe mental illness.American Journal of Psychiatry,159(8),1395-1402.
23. Hoffmann, H.,Kupper, Z.,Zbinden, M.,Hirsbrunner, H. P.(2003).Predicting vocational functioning and outcome in schizophrenia outpatients attending a vocational rehabilitation program.Social Psychiatry and Psychiatric Epidemiology,38(2),76-82.
24. Hogan, T. P.,Awad, A. G.,Eastwood, R.(1983).A self-report scale predictive of drug compliance in schizophrenics: Reliability and discriminative validity.Psychological Medicine,13,177-183.
25. Kaustav, C.,Debasish, B.(2010).Insight in schizophrenia - A comprehensive update.German Journal of Psychiatry
26. Law, C. K. M.,Siu, A. M. H.,Lee, J. L. Y.,Lee, S. W. K.(2006).Prediction of work rehabilitation placements using the Chinese work personality profile.Psychiatric Rehabilitation Journal,30(2),120-128.
27. Liberman, R. P.,Mueser, K. T.,Wallace, C. H.,Jacobs, H. E.,Eckman, T.,Massel, H. K.(1996).Training skill in the psychiatrically disabled: Learning coping and competence.SchizophreniaBulletin,12(4),631-647.
28. Link, B.,Struening, E.,Neese-Todd, S.,Asmussen, S.,Phelan, J.(2001).Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses.Psychiatric Services,52,1621-1626.
29. Lysaker, P.,Bell, M.,Milstein. R.,Bryson, G.,Beam-Goulet, J.(1994).Insight and psychosocial treatment compliance in schizophrenia.Psychiatry,57,307-315.
30. Lysaker, P.,Bryson, G. J.,Bell, M.(2002).Insight and work performance in schizophrenia.Journal of Nervous and Mental Disease,190,142-146.
31. Macdonald, E.,Pica, S.,Mcdonald, S.,Hayes. R.,Baglioni, A. J.(1998).Stress and coping in early psychosis. Role of symptoms, self-efficacy, and social support in coping with stress.Brisital Journal Psychiatry,172(33),122-127.
32. Macpherson, R.,Double, D.,Rowlands, R.,Harrison, D.(1993).Long-term psychiatric patients' understanding of neuroleptic medication..Hospital Community Psychiatry,44(1),71-73.
33. McCay, E. A.,Seeman, M. V.(1998).A scale to measure the impact of schizophrenic illness on an individual's self-concept.Archives of Psychiatric Nursing,12(1),44-49.
34. McDermott, B. E.(1995).Development of an instrument for assessing self-efficacy in schizophrenic spectrum disorders.Journal of Clinical Psychology,51(3),320-331.
35. Michon, H. W. C.,Weeghel, J.,Kroon, H.,Schene, A. H.(2005).Person-related predictors of employment outcomes after participation in psychiatric vocational rehabilitation programmes: A systematic review.Social Psychiatry and Psychiatric Epidemiology,40(5),408-416.
36. Mueser, K. M.,Meyer, P. S.,Penn, D. L.,Clancy, R.,Clancy, D. M.,Salyers, M. P.(2006).The illness management and recovery program: Rationale, development, and preliminary findings.Schizophrenia Bulletin,32(1),32-43.
37. Parent, W. S.,Hill, M. L.,Wehman, P.(1989).From sheltered to supported employment outcomes: Challenges for rehabilitation facilities.Journal of Rehabilitation,55(4),51-57.
38. Provencher, H. L.,Gregg, R.,Mead, S.,Mueser, K. T.(2002).The role of work in the recovery of persons with psychiatric disabilities.Psychiatric Rehabilitation Journal,26(2),132-144.
39. Regenold, M.,Sherman, M. F.,Fenzel, M.(1999).Getting back to work: Self-efficacy as a predictor of employment outcome.Psychiatric Rehabilitation Journal,22(4),361-367.
40. Ritsher, J. B.,Otilingam, P. G.,Grajales, M.(2003).Internalized stigma of mental illness: Psychometric properties of a new measure.Psychiatry Research,121,31-49.
41. Spaniol, L.,Wewiorski, N.,Gagne, C.,Anthony, W.(2002).The process of recovery from schizophrenia.International Review of Psychiatry,14(4),327-336.
42. Tsang, H.,Lam, P.(2000).Predictors of employment outcome for people with psychiatric disabilities: A review of the literature since the mid `80s.Journal of Rehabilitation,66(2),19-31.
43. Waghorn, G. R.,Chant, D. C.,King, R.(2007).Work-related subjective experiences, work-related self-efficacy, and career learning among people with psychiatric disabilities.American Journal of Psychiatric Rehabilitation,10,275-300.
44. Waghorn, G.,Chant, D.,Whiteford, H.(2003).The strength of self-reported course of illness in predicting vocational recovery for persons with schizophrenia.Journal of Vocational Rehabilitation,18,33-41.
45. Wells, J. S. G.(2006).Hospital-based industrial therapy units and the people who work within them - an Irish case analysis using a soft-systems approach.Psychiatric and Mental Health Nursing,13,139-147.
46. Whitehead, C. W.(1979).Sheltered workshops.Effective accommodation or exploitation?.Amicus,4,273-275.
47. Zubin, J.,Spring, B.(1977).Vulnerability: A new view on schizophrenia.Journal of Abnormal Psychology,86,103-126.
48. 王仕圖、黃鈺婷(2008)。非營利組織從事就業服務之政策省思與展望與展望─以身心障礙者庇護性就業為例。社區發展季刊，122，29-46。
49. 白倩如(2004)。碩士論文(碩士論文)。東海大學社會工作學系。
50. 成和玲、余伍洋(1997)。「藥物態度量表」中文版之信效度評估。高雄醫學科學雜誌，13(6)，370-377。
51. 余靜雲(1999)。碩士論文(碩士論文)。高雄醫學大學護理學研究所。
52. 吳明宜、汪翠瀅(2005)。工作行為衡量表的研發與心理計量初探。職能治療學會雜誌，23，74-85。
53. 林美伶、熊秉荃、林淑蓉、胡海國(2002)。精神分裂症患者之烙印處境。慈濟醫學雜誌，14(6)，381-188。
54. 林靜蘭(2007)。博士論文(博士論文)。國立臺灣大學醫學院護理學研究所。
55. 施陳美津、吳明宜、蘇純瑩、張志仲(2002)。行政院勞工委員會勞工安全衛生研究所研究報告行政院勞工委員會勞工安全衛生研究所研究報告,行政院勞工委員會勞工安全衛生研究所。
56. 范珈維、張彧、潘璦琬(2007)。精神障礙者重返工作之因素探討：文獻回顧。台灣職能治療研究與實務，3(2)，61-71。
57. 高麗芷、葉美堃、林民裕、褚增輝、周美華、黎曉鶯(1980)。職能治療綜合評量表之設計。中華心理學刊，23(1)，1-7。
58. 郭乃文、劉秀枝、王珮芳、徐道昌(1989)。中文版「簡短式智能評估」（MMSE）之簡介。臨床醫學，23(1)，39-42。
59. 郭乃文、劉秀枝、王珮芳、廖光淦、甄瑞興、林恭平、徐道昌(1988)。「簡短式智能評估」之中文施測與常模建立。復健醫學雜誌，16，52-59。
60. 曾文星、徐靜(1998)。現代精神醫學。台北:水牛。
61. 楊翠媛、林美娟、李青霖、陳翠如(2008)。建構社區精神衛生護理能力─疾病管理。精神衛生護理雜誌，3(2)，30-34。
62. 葉東豐(2008)。碩士論文(碩士論文)。東吳大學社會工作學系。
63. 劉佳華(2007)。碩士論文(碩士論文)。國立彰化師範大學復健諮商研究所。
64. 蔡欣玲、陳美碧(1996)。某醫學中心精神科病人出院後回診規律性相關因素之探討。護理研究，4(1)，69-78。
65. 謝美惠(2006)。碩士論文(碩士論文)。國立高雄師範大學特殊教育研究所。
66. 鍾信心、顏正芳、葉明莉(1998)。行政院國家科學委員會專題研究畫報告行政院國家科學委員會專題研究畫報告,行政院國家科學委員會。
67. 蘇聆喬(2008)。碩士論文(碩士論文)。國立高雄師範大學復健諮商研究所。

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