個人及健康照護體系復原力之理論與應用

Resilience of Individual and Health Care System: Theory and Application

10.53106/168232812021123104002

李國任(Kuo-Jen Li)；蕭文棋(Wen-Chi Hsiao)；劉金明(Chin-Ming Liu)；顏啟華(Chi-Hua Yen)

復原力 ； 健康照護體系 ； 嚴重特殊傳染性肺炎 ； COVID-19 ； health care system ； resilience

台灣家庭醫學雜誌

31卷4期（2021 / 12 / 01）

258 - 268

繁體中文

近年來復原力的觀念逐漸受到重視，去年全球嚴重特殊傳染性肺炎疫情盛行，此議題再度被廣泛討論，本文旨在回顧國內外文獻，闡述復原力的定義、理論及學術與臨床上的運用。個人復原力定義為「面對重大壓力、創傷和逆境，協調、處理以及適應的過程」，健康照護體系復原力定義為「體系面臨危機時，應變與維持功能，汲取經驗並重新整頓的能力」。建構個人復原力的內在因子包括自尊心、自我感覺、個人競爭力、社會競爭力、外向性和開放性，外在因子包括天然環境、人為環境、社會網絡及教育，目前已有各式評估量表可應用於臨床研究。健康照護系統復原力則應具備資訊處理、解決問題、建構組織和適應轉型的能力。我們可由復原力矩陣觀察體系適應事件的階段及面向，評估其復原力。持續性的心理諮商、教育訓練、自我學習及團體活動可增強個人復原力，而健康照護體系復原力則須完善整體規劃。復原力可應用於家庭醫學各項臨床業務中，以提升照護品質，在經營及管理上亦可應用復原力觀念，提高單位的應變能力。學術研究方面，未來可發展更適當的評估工具，或對特定對象進行復原力分析或介入成效評估，亦可發展資訊系統建構。總結以上，擁有良好復原力可提升個人心理衛生狀態、促進社區健康並完善健康照護體系，在臨床與學術上也能有良好發展，個人或體系面對未來的各種重大事件衝擊上，也能有更充足的準備。

Individual and health system resilience has been an issue drawing increasing attention in recent years, especially after the outbreak of the COVID-19 pandemic. This article reviews studies on resilience, including its definition, theory and applications. Individual resilience is generally defined as ＂a process of negotiating, managing, and adapting to significant sources of stress or trauma.＂ Health system resilience, on the other hand, refers to ＂the ability to adjust, adapt, learn, and transform to maintain essential functions when health care institutes, their members and people are facing serious events.＂ Individual resilience is constructed and related to acceptance, optimism, self-esteem, competence, extroversion, and openness. Extrinsic factors are related to environment, society and education. Several evaluation scales have been developed. We can improve individual resilience by continuous counseling, education, and group activities. Health system and institutes resilience can also be improved by detailed planning. The concept of resilience can apply to family physicians' daily clinical practice to help enhance primary care quality. It can also be used to manage a subspecialty, local clinic, or hospital. There are also plenty of developments in the field of research, including intervention, evaluation, and system construction. In summary, resilience contributes not only to personal physical and mental wellbeing but also to the ongoing improvement of social support and health systems, helping individuals, communities, and institutions better prepare for future events.

1. Han, J,Zhou, XP,Liu, JE,Yue, P,Gao, L(2020).The Process of Developing Resilience in Patients With Burn Injuries.J Nurs Res,28,e71.
   連結：
2. 吳相儀,張聖翎,蕭舒謙,簡晉龍(2018)。感恩到幸福：從復原力探討感恩與心理健康之關係。教育心理學報，50，83-106。
   連結：
3. Aitsi-Selmi, A,Murray, V(2015).The Sendai framework: disaster risk reduction through a health lens.Bull World Health Organ,93,362.
4. Biddle, L,Wahedi, K,Bozorgmehr, K(2020).Health system resilience: a literature review of empirical research.Health Policy Plan,35,1084-1109.
5. Blanchet, K,James, P(2013).The role of social networks in the governance of health systems: the case of eye care systems in Ghana.Health Policy Plan,28,143-156.
6. Blanchet, K,Nam, SL,Ramalingam, B,PozoMartin, F(2017).Governance and capacity to manage resilience of health systems: towards a new conceptual framework.Int J Health Policy Manag,6,431-435.
7. Carlson, JL,Haffenden, RA,Bassett, GW.,未出版
8. Chen, X,Wang, Y,Yan, Y(2016).The Essential Resilience Scale: Instrument development and prediction of perceived health and behaviour.Stress Health,32,533-542.
9. Cheshire, A,Hughes, J,Lewith, G(2017).GPs’ perceptions of resilience training: a qualitative study.Br J Gen Pract,67,e709-e715.
10. Cohen, S,Janicki-Deverts, D,Miller, GE(2007).Psychological stress and disease.JAMA,298,1685-1687.
11. Douillet, D,Caillaud, A,Riou, J(2021).Assessment of physicians’ resilience level during the COVID-19 pandemic.Transl Psychiatry,11,283.
12. Dugani, S,Veillard, J,Evans, TG(2018).Quality primary health care will drive the realization of universal health coverage.CMAJ,190,453-e454.
13. Duraković-Belko, E,Kulenović, A,Dapić, R(2003).Determinants of posttraumatic adjustment in adolescents from Sarajevo who experienced war.J Clin Psychol,59,27-40.
14. Feder, A,Nestler, EJ,Charney, DS(2009).Psychobiology and molecular genetics of resilience.Nat Rev Neurosci,10,446-457.
15. Fritz, J,Stochl, J,Goodyer, IM,van Harmelen, AL,Wilkinson, PO(2020).Embracing the positive: an examination of how well resilience factors at age 14 can predict distress at age 17.Transl Psychiatry,10,272.
16. Garcia-Dia, MJ,DiNapoli, JM,Garcia-Ona, L,Jakubowski, R,O’Flaherty, D(2013).Concept analysis: resilience.Arch Psychiatr Nurs,27,264-270.
17. Haldane, V,Zhang, Z,Abbas, RF(2020).National primary care responses to COVID-19: a rapid review of the literature.BMJ Open,10,e041622.
18. Holling, CS(1973).Resilience and stability of ecological systems.Ann Rev Ecol Evol Syst,4,1-23.
19. Hollnagel, E(2009).The four cornerstones of resilience engineering.Resilience Engineering Perspectives. Volume 2: Preparation and Restoration,UK:
20. Johnson, J,Simms-Ellis, R,Janes, G(2020).Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention.BMC Health Serv Res,20,1094.
21. Jovanović, A,Klimek, P,Renn, O(2020).Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks, resilience indicators, interdependencies and international standards.Environ Syst Decis,4,1-35.
22. Joyce, S,Shand, F,Tighe, J,Laurent, SJ,Bryant, RA,Harvey, SB(2018).Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions.BMJ Open,8,e017858.
23. Kim, GM,Lim, HS,Lim, JY,Kim, SS,Kim, EJ(2019).Effects of a Family Resilience Enhancement Program (FREP) on Family Adaptation to Elderly with Dementia in South Korea.Int J Gerontol,13,54-58.
24. Klasa, K,Galaitsi, S,Wister, A,Linkov, I(2021).System models for resilience in gerontology: application to the COVID-19 pandemic.BMC Geriatr,21,51.
25. Koay, WI,Dillon, D(2020).Community gardening: stress, well-being, and resilience potentials.Int J Environ Res Public Health,17,6740.
26. Kruk, ME,Myers, M,Varpilah, ST,Dahn, BT(2015).What is a resilient health system? Lessons from Ebola.Lancet,385,1910-1912.
27. Kutzin, J,Sparkes, SP(2016).Health systems strengthening, universal health coverage, health security and resilience.Bull World Health Organ,94,2.
28. Lim, ML,Lim, D,Gwee, X,Nyunt, MS,Kumar, R,Ng, TP(2015).Resilience, stressful life events, and depressive symptomatology among older Chinese adults.Aging Ment Health,19,1005-1014.
29. Linkov, I,Bridges, T,Creutzig, F(2014).Changing the resilience paradigm.Nat Clim Chang,4,407-409.
30. Liu, Y,Li, Y,Chen, L,Li, Y,Qi, Y,Yu, L(2018).Relationships between family resilience and posttraumatic growth in breast cancer survivors and caregiver burden.Psychooncology,27,1284-1290.
31. Masten, AS,Reed, M(2002).Resilience in development.Handbook of Positive Psychology,UK:
32. Robertson, D(2012).Build Your Resilience: CBT, Mindfulness and Stress Management to Survive and Thrive in any Situation.UK:Hodder & Stoughton.
33. Robertson, IT,Cooper, CL,Sarkar, M,Curran, T(2015).Resilience training in the workplace from 2003 to 2014: A systematic review.J Occup Organ Psychol,88,533-562.
34. Steel, Z,Chey, T,Silove, D,Marnane, C,Bryant, RA,van Ommeren, M(2009).Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis.JAMA,302,537-549.
35. Stewart, DE,Yuen, T(2011).Systematic Review of Resilience in the Physically Ill.Psychosomatics,52,199-209.
36. Tugade, MM,Fredrickson, BL(2004).Resilient individuals use positive emotions to bounce back from negative emotional experiences.J Pers Soc Psychol,86,320-333.
37. Wang, C,Grassau, PA,Lawlor, PG(2020).Burnout and resilience among Canadian palliative care physicians.BMC Palliat Care,19,169.
38. Wild, J,El-Salahi, S,Degli-Esposti, M,Thew, GR(2020).Evaluating the effectiveness of a group-based resilience intervention versus psychoeducation for emergency responders in England: A randomised controlled trial.PLoS One,15,e0241704.
39. Windle, G,Bennett, KM,Noyes, J(2011).A methodological review of resilience measurement scales.Health Qual Life Outcomes,9,8.
40. Wright, N,Fagan, L,Lapitan, JM(2020).Health emergency and disaster risk management: five years into implementation of the Sendai Framework.Int J Disaster Risk Sci,11,206-217.
41. Yuan, Y(2021).Mindfulness training on the resilience of adolescents under the COVID-19 epidemic: a latent growth curve analysis.Pers Individ Dif,172,110560.
42. 行政院衛生福利部：2018臺灣全球健康論壇「韌力、復原力：全球健康的挑戰與契機」。2018年10月28日，取自https://www.mohw.gov.tw/cp-16-44934-1.html.
43. 呂俊良(2000)。復原力對諮商的啟示。輔導季刊，36，32-36。
44. 謝為任(2020)。淺談心理健康促進之復原力。教育臺灣教育評論月刊，9，82-87。

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2. (2024)。新冠肺炎重症病人隔離期間重建復原力之照護經驗。志為護理-慈濟護理雜誌，23(1)，118-127。