探究慢性思覺失調症病人復元歷程中與家人互動經驗

Exploring the family interactional experience of patients having chronic schizophrenia during their recovering process

10.6847/TJPMHN.202012_15(2).01

吳佳芬(Chia-Fen Wu)；靖永潔(Yung-Chieh Ching)

慢性思覺失調症 ； 復元歷程 ； 家人互動 ； 質性研究 ； chronic schizophrenia ； recovering process ； family interaction ； qualitative inquiry

精神衛生護理雜誌

15卷2期（2020 / 12 / 01）

6 - 13

繁體中文

本研究目的為探討慢性思覺失調症病人在疾病復元歷程中與家庭互動的經驗。以質性研究方法，於中部某精神科專科醫院之社區復健中心立意選取成年、具慢性思覺失調症診斷、與家人同住一年以上及接受社區復健服務6個月以上之病人為研究對象。透過一對一深入訪談，以內容分析法分析及統整歸納，訪談10位慢性思覺失調症個案至資料呈現飽和狀態。研究結果包括四大主題：（一）配合家人所採取之民俗治療與醫學治療、（二）承接家人對待之支持與否定、（三）順應家人對待而產生自我肯定與否定、（四）因應家人對待而產生責任承擔與無所謂。研究結果顯示病人容易承擔家人對疾病態度，配合家人所要求的治療模式，也因與家人相處情形，影響其自我肯定以及後續發展出角色責任感。本研究建議，宜教導病人與同住家人一同學習有效而正向的表達方式與期待，共同接納與因應疾病，以利其邁向復元。

This study aimed to explore the family interactional experience of patients having chronic schizophrenia during their recovering process. By using qualitative inquiry methods, we have in-depth interviewed 10 randomly-selected middle-aged adult patients from the community rehabilitation center of a psychiatric hospital in central Taiwan. Patients were recruited if they were diagnosed of chronic schizophrenia, have lived with their family for at least over 1 year, and have received community rehabilitation service for more than 6 months. Data were collected until data saturated and examined via content analysis. Four main themes were emergede: (1) receiving folk remedy and medical treatment requested by family members; (2) accepting whatever family members give support or negation were; (3) generating a sense of self-affirmation and negation based on how they were treated by their family members; and (4) showing a responsive or indifferent attitude according to how their family members responded to them. The results indicate that patients having suffered from schizophrenia would tend to assume the attitude that their family members hold towards their disease, and thus would automatically choose the modes which their family members preferred them to react to and comply with their family's interactive expectations. Therefore, we suggest that patients having schizophrenia and living with their family members should be instructed to learn how to interact effectively through positive expressions and mutual expectations to facilitate recovery.

1. 宋麗玉(2005)。精神障礙者之復健與復元-一個正向積極的觀點。中華衛生心理學刊，18，1-29。
   連結：
2. 黃耀輝,林幼喻,李世凱,李明峰,林靜蘭(2017)。精神病患復元歷程之相關性研究。護理雜誌，65(2)，64-74。
   連結：
3. 劉幸愉,林盈彣,顏文娟,黃耀輝,簡以嘉,馬維芬(2019)。探討思覺失調症住院病人之復元程度及相關因素。精神衛生護理雜誌，14(2)，20-29。
   連結：
4. 韓德彥,陳淑惠(2008)。精神疾病汙名感受量表及短版之心理計量特性。中華心理衛生學刊，21(3)，273-290。
   連結：
5. Barber, M. E.(2012).Recovery as the new medical model for psychiatry.Psychiatric Services,63(3),277-279.
6. Cechnicki, A.,Wojciechowska, A.,Valdez, M.(2008).The social network and the quality of life of people suffering from schizophrenia seven years after the first hospitalization.Archives of Psychiatry and Psychotherapy,2,31-38.
7. Kaewprom, C.,Curtis, J.,Deane, F. P.(2011).Factors involved in recovery from schizophrenia: A qualitative study of Thai mental health nurses.Nursing and Health Sciences,13,323-327.
8. Kuo, J.,Lin, S. K.(2010).Functional recovery in schizophrenia.Taiwanese Journal of Psychiatry,24(2),87-98.
9. Lincoln, Y. S.,Cuba, E. G.(1985).Naturalistic Inquiry.Sage Publications.
10. Lysaker, P. H.,Buck, P. H.(2008).Is recovery from schizophrenia possible？An overview of concepts, evidence, and clinical implications.Primary Psychiatry,15(6),60-65.
11. Mohr, S.,Brandt, P. Y.,Borras, L.,Gilliéron, C.,Huguelet, P.(2006).Toward an integration of spirituality and religiousness into the psychosocial dimension of Schizophrenia.American Journal of Psychiatry,163(11),1952-1959.
12. Oexle, N.,Müller, M.,Kawohl, W.,Xu, Z.,Viering, S.,Wyss, C.,Rüsch, N.(2018).Self-stigma as a barrier to recovery: A longitudinal study.European Archives of Psychiatry and Clinical Neuroscience,268(2),209-212.
13. Tesch, R.(1990).Qualitative research: Analysis types and software tool.Falmer.
14. Wood, L.,Byrne, R.,Burke, E.,Enache, G.,Morrison, A. P.(2017).The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalized shame and self-esteem.Psychiatry Research,255,94-100.
15. World Health Organization.(2018). Schizophrenia. Retrieved from http:www.who.int/en/news-room/fact-sheets/detail/schizophrenia.
16. 吳就君,黃梅羹,胡海國,蔡春美,鄭若瑟,張宏俊,鄭夙芬(2001)。精神分裂症病患照顧者表露情緒與社會心理因素之關係—兩年追蹤研究。臺大社工工作學刊，4，3-44。
17. 宋麗玉(2013)。,未出版
18. 李依蓁(2010)。花蓮市，私立花蓮慈濟大學社會工作學系。
19. 李選（校閱）(2013).護理研究與應用.華杏.
20. 沈淑華(2007)。台南市，國立成功大學護理學系碩士班。
21. 林慧婷(2014)。台北市，國立臺北大學社會工作學系。
22. 邱筠雅(2011)。台北市，國立臺北大學社會工作學系。
23. 梅黎晞(2006)。花蓮縣，國立東華大學族群關係與文化研究所。
24. 郭芬如(2013)。台北市，國立台灣師範大學社會工作學研究所。
25. 劉玲君(2014)。台北市，國立臺北大學社會工作學系。
26. 衛生福利部統計處（2019，8 月 30 日）．身心障礙者人數按季．取自 https://dep.mohw.gov.tw/DOS/cp-2976-13815-113.html
27. 駱敏靈,熊衛,馬曼,張建軍,李軼琛,馬筠,徐漢明(2014)。精神分裂症患者原生家庭互动模式的定性研究。中國心理衛生雜誌，28(11)，840-845。
28. 蘇舜君(2014)。台北市，國立台灣師範大學社會工作學研究所。

1. (2024)。思覺失調症患者家屬陪伴患者回歸社區其生命經驗之敘事研究。教育心理學報，55(3)，459-490。
2. (2024)。運用賦權策略改善一位慢性思覺失調症病人自我照顧能力缺失之護理經驗。精神衛生護理雜誌，19(1)，33-39。