DSM-5變革、護理教育接軌與精神衛生護理本質之反思

The Interface between DSM-5 and Nursing Education, and Reflection on Nature of Mental Health Nursing

10.6847/TJPMHN.201806_13(1).02

呂雀芬(Chueh-Fen Lu)；葉美玉(Mei-Yu Yeh)；董靜娟(Ching-Chuan Tung)

DSM-5 ； 護理教育 ； 精神衛生護理本質 ； DSM-5 ； nature ； mental health nursing ； nursing education

精神衛生護理雜誌

13卷1期（2018 / 06 / 01）

5 - 13

繁體中文

台灣精神醫學會（2014）因應美國精神醫學會出版精神疾病診斷與統計手冊第五版（Diagnostic and statistical manual of mental disorders fifth edition, DSM-5），出版中文本，期能銜接最新醫學發展於台灣文化脈絡。面對DSM-5變革，台灣護理教育與臨床該如何因應，是迫切的議題。本文旨在討論其變革、脈絡與批判、探討護理教育與臨床實務該如何因應及反思精神衛生護理的本質。包括三重點：(1)DSM-5主要變革包括類群取徑、放寬診斷標準等，但也遭到過度醫療化之批判。(2)對精神衛生護理專業之挑戰，建議從知識面與培養多元反思能力以接軌此變革。(3)精神衛生護理本質包含以護病關係為核心之同在性、日常生活導向等實務特質。從DSM-5修訂過程，我們學習新的分類思維，在醫療觀點之外看見疾病建構的社會與政治因素，如利益團體角色、文化因素等。藉著跨專業的異質比較與梳理論述，更能釐清護理專業獨特性，是異於病理角度與社會學批判思維。精神衛生護理本質即以人為本，關注疾病變化，亦重視病人與家屬的觀點，運用護病關係賦能病人及豐富精神衛生照護實質內涵。

In order to respond to the latest version of Diagnostic and statistical manual of mental disorders, DSM 5, was issued by American Psychiatric Association, Taiwan Society of Psychiatry published Chinese version of DSM 5 in 2014. It is expected to connect the latest knowledge of psychiatry in line with Taiwanese culture. Similarly, for nursing education and clinical practice of mental health in Taiwan, it is a vital issue in response to the latest version of DSM. This paper aims to discuss the changes, context and critique of DSM-5, and how nursing profession reacts upon it, and how its influences on the nature of mental health nursing in Taiwan. In sum, there are as follows: 1. The major changes of DSM-5 include spectrum approach, which lowers the criteria of diagnoses of some illness. One of the major criticism is medical dependence in life. 2. Nursing profession is expected in need to learn the idea of change behind the changes of classification systems. The ability of reflection from diverse aspects outside medical viewpoints needs to be enhanced. 3. The nature of mental health nursing includes the professional nurse's presence with patients, who have pragmatic characteristics. Via the changes of DSM-5, it motivates nursing profession to reflect on practice and nature of mental health nursing. Our uniqueness can be distinguished by comparing with disciplines, that is, nursing focus more on patients' daily lives instead of the standpoints of pathological or social criticism. The essence of mental health nursing lies in its emphasis on the people-oriented principle, in which focuses are directed not only on caring for patients' progress in their treatments but also on taking account of patients' and their family's points of view into consideration; thereby the patients can be empowered through nurse-patient relationship, and the contents of mental health nursing can be substantially enriched.

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