社區精神病患之照護需求－系統性文獻回顧

A Systematic Review on Care Needs of Mentally-ill Patients in the Community

10.6847/TJPMHN.201212_7(2).0002

劉玟宜(Wen-I Liu)；戎瑾如(Jiin-Ru Rong)；李坤黛(Kuen-Tai Lee)

系統性文獻回顧 ； 精神病患 ； 社區需求 ； systematic review ； mentally-ill patients ； needs in the community

精神衛生護理雜誌

7卷2期（2012 / 12 / 01）

1 - 13

繁體中文

背景：臺灣精神衛生政策逐漸強化社區精神病患之照護，精神衛生護理人員須掌握個案之照護需求，以提升其社區生活品質。目前鮮少整合性文獻闡述社區精神病患之照護需求。方法：本文依形成問題、文獻搜尋、篩選文獻、文獻品質評析及萃取整合資料之步驟進行系統性文獻回顧。國外文獻選取電子資料庫CHINAHL，PUBMED；國內文獻則以臺灣期刊論文索引及碩博士論文系統為搜尋平台，運用可能之同義關鍵字搜尋，逐一閱讀題目及摘要過濾符合之文獻後，兩位作者同時以非隨機測試文獻評析標準選取進入回顧之文獻，最後進行萃取並整合結果。結果及討論：本文共回顧18篇英文及4篇中文論文。將每篇所提之需求項目逐一列舉，最常出現五項需求為：處理精神症狀、支持性就業、金錢福利、處理心理困擾及自我照顧技能。本文依操作性定義所做次級資料項目將其分為六類需求：疾病管理、危機處置、心理復元、生活管理、家庭支持及社會參與之需求。依需求性質可歸納為醫療照護及社區適應兩大面向。社區精神病患需要多元化、橫跨多專業之整合及持續性個案管理實證照護模式。結論／實務應用：本系統性文獻回顧結果可作為發展具實證基礎之社區精神病患需求評估工具發展社區精神衛生持續性照護模式及照護能力之具體參考。

Background: Taiwanese psychiatric mental health policy is increasingly highlighting the care of the mentally-ill patients in the community. Mental health nurses should satisfy each case whose individual needs to improve the quality of life in the community. However, there is limited integrated literature pertaining to the care needs of the mentally-ill patients in the community. Hence, this study aims to fill the insufficiency by conducting a systematic review on this issue. Methods: This paper carried out the following five steps to conduct the systematic review: 1. formulating the review question; 2. conducting a literature search; 3. selecting studies for inclusion or exclusion; 4. appraising the quality of articles; and 5. synthesizing the evidence. This study adopted CHINAHL and PUBMED as the electronic database of foreign literature. In addition, the Index to the Taiwan Periodical Literature System and the National Digital library of theses and dissertations in Taiwan served as the databases for domestic literature. According to the standard literature screening procedures, some articles were selected and analyzed separately by two co-authors. Results: A total of 18 papers in English and 4 articles in Chinese were reviewed. The items of needs mentioned in the article were marked in red; these items were then classified according to their nature. The five most common needs/concerns were psychotic symptoms, supported-employed, money, psychological distress, and self-care. The needs of the mentally-ill patients in the community include the following six categories: disease management, crisis intervention, recovery, daily life management, family support, and social involvement. The community services required for the mentally-ill patients range widely across multiple disciplines. A model of integrated and continuing evidence-based case management is necessary to fulfill the complex needs. Conclusions/Implications for practice: The results of the study can provide evidence-based items to be used as tools for a revised needs-assessment and for the development of an integrated care model for the mentally-ill patients in the community. Moreover, those data can also serve as the guidelines for developing a continuing and integrated evidence-based care model for the mentally-ill patients in the Taiwanese community.

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