探討某區域醫院精神病患出院準備服務之成效

Exploring the Effectiveness of the Discharge Nursing Service of a District Hospital for Patients with Psychotic Disorders

10.6847/TJPMHN.200912_4(2).0001

蕭淑貞(Shu-Jen Shiau)；李依玲(I-Ling Li)；康云瑄(Yun-Xuan Kang)；楊秋月(Chiu-Yueh Yang)；張凱雁(Kai-Yen Chang)；黎于萍(Yu-Ping Li)；楊聰財(Tsung-Tsair Yang)

精神病患 ； 出院準備服務 ； psychotic disorder ； discharge planning

精神衛生護理雜誌

4卷2期（2009 / 12 / 01）

1 - 11

繁體中文

精神病患除急性期醫院的醫療照護外，出院後合適的持續性照顧亦非常重要，可增進疾病的管理及生活品質，若能提供出院準備服務於病患，將可以增加個案出院後的生活適應、減少症狀干擾、增進自我功能、提高生活品質及降低再住院治療的機會，可見出院準備服務之重要性，本研究之目的為：探討出院準備服務之護理服務對增進精神病患症狀控制、服藥規則性、服務資源、自我照顧能力、自我照顧依賴程度、家庭功能、困擾程度、因應效能之成效、本研究採用類實驗法(quasi-experiments)，收案對象為某醫院精神科急性病房精神病患，收案方法為立意取樣，並且尊重病人意願。控制組精神病患者30名個案沿用原本的護理服務方式，實驗組30名個案則用出院準備的護理服務，控制因素為診斷、年齡，評量指標為正性症狀、負性症狀、情緒症狀、服藥遵從、服務資源、自我照顧能力、自我照顧依賴程度、家庭功能、困擾程度、因應效能等。資料分析採描述性統計及推論性統計之無母數配對T檢定。研究結果為：經出院準備服務後其困擾程度確實有顯著的改善，及服務資源獲得增加，兩組在服務滿意度及困擾程度前後測評量差異均達到統計上的顯著意義。建議未來可增加出院準備服務持續的時間，爭取持續性護理人力、發展護理人員的實務能力及培訓，和進一步進行效益評估的研究。

Acute medical care aside, a very important question for patients with mental disorders is that of which of them will receive continuous care after discharge in order to improve their symptom management and quality of life. The purpose of this study was to explore the effectiveness of the discharge nursing model on symptom management, regularity of drug administration, service resources, self care, dependency, family function, disturbance, and coping adaptation. A quasi-experimental research design was applied. Subjects were recruited from a general hospital. Traditional nursing services were provided to 30 psychotic patients who served as the control group. Services based on the discharge nursing model were provided to 30 psychotic patients who served as the experimental group. The control variables were diagnosis and age. The evaluation criteria were positive symptoms, negative symptoms, emotional symptoms, compliance with drug administration requirements, service resources, self-care, dependency, family function, disturbance, and coping effectiveness. Data analysis included descriptive and inferential statistics. The results demonstrated significant differences between the two groups in pre-test and post- test variance scores for service satisfaction and disturbance levels. The study recommends increasing manpower for continuous nursing care, developing nurses’ clinical competency and training, and advanced research in effectiveness evaluation.

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