臺灣博碩士論文加值系統

近年來，國內屢見強制精神病患送醫過程中發生意外事件。現今社區精神病患的照護体系及法規，仍有缺乏完善之處，值得探討。研究目的在瞭解公共衛生護士強制精神病患送醫之意願相關因素。本研究採橫斷性調查法，問卷內容包括人口學、專業經驗、資源、困難及執行意願等變項。困難及意願題目採四點量表計分。研究對象為中部地區彰化縣、南投縣、台中縣、台中市、雲林縣等衛生所之公衛護士。調查期間自95 年8 月至9 月止，共發出641 份，回收有效問卷為635 份(98%)。以SPSS/PC12.0 套裝軟體進行分析。
結果發現，有91.8%護士表示與危險精神病患接觸有困難，70.8%擔心被告強制送醫之合法性。經分析發現，執行經驗、上級單位支持度以及感受到執行的困難度等三者為與執行意願最密切的主要因素。近二年曾處置過強制送醫者，意願較低；感受到衛生局主辦人員
支持度高者，其意願高；感到強制送醫困難度愈高者，其意願愈低。加強公共衛生護士接觸危險精神病患之專業能力，衛生局主管業務人員主動支持，以及整合強制送醫之流程，將可提高公衛護士執行意願。

Objective：Some adverse events happened during the coerced treatment
process of psychiatric patients Taiwan in recent years. It is worthwhile to find out the shortcomings of the present caring system and regulations of the mental health community in Taiwan. This study aims to explore the influence factors to the willingness of Taiwan public health nurses to send psychiatric patients coerced treatment.
Method：The study is a cross-sectional survey, and a self-administered
questionnaire which was developed for this study. The questions consist of variables such as demography, professional experiences, resources, execution difficulties, and execution willingness. Among the questions, the ones concerning difficulties and willingness were all evaluated using a four-point scale. Data on all public health nurses working in middle Taiwan including these five areas: Changhua County, Nantou County, Taichung County, Taichung City, and Yunlin County. The questionnaire was collected from August to September 2006. 635 nurses (98%) out of 641 anonymous ones responded to the questionnaire. Data was analyzed by descriptive method and logistic regression (SPSS/PC120 bundled software).
Results：Study results indicated that 91.8% claimed they had difficulties contacting the patients, and 70.8% worried about the legitimacy of coerced treatment process. Additional analysis showed three major factors affecting nurses’ willingness of carrying out coercive treatment process: execution experiences, the level of support from superintendents, and the degree of difficulties confronted during the procedure. Those who ever dealt with coerced treatment patients in the last two years were less willing; those who had higher support from the officers of local health bureau were more willing; those who experienced higher degree of difficulties at the process were again less willing. Conclusions ： The study suggests strengthening professional ability training programs for the public health nurses to deal with dangerous psychiatric patients. The local bureau in charge should actively finds out the obstacles that executors are facing, and also positively support and integrate the coerced treatment procedure.

目錄
第一章緒論-1
第一節研究緣起-l
第二節研究重要性-3
第三節研究目的- 5
第四節名詞界定-5
第二章文獻探討-7
第一節國內外精神醫療資源及強制送醫發展-7
第二節公共衛生護士強制送醫意願之相關因素-16
第三節公共衛生護士強制送醫之困難-24
第三章研究方法- 27
第一節研究設計及工具-27
第二節研究對象-34
第三節資料分析-34
第四章研究結果-36
第一節公共衛生護士之人口學及特性之分佈-36
第二節公共衛生護士強制送醫意願及困難之分佈-40
第三節公共衛生護士強制送醫意願之相關因素結果-48
第五章討論-54
第一節公共衛生護士人口學、資源與強制送醫意願之分析-54
第二節縣市別公共衛生護士強制送醫困難與意願之分析-56
第三節公共衛生護士強制送醫意願及相關因素之分析二-57
第四節公共衛生護士強制送醫的困難分析-60
第六章結論與建議-64
第一節結論-64
第二節建議-64
第三節對未來研究者之建議-66
第四節研究限制-67
參考文獻-68
附錄-76
附錄一精神衛生法修正草案說明（立法院一讀通過）-76
附錄二凱旋醫院提供高雄市處置流程- 81
附錄三彰化縣社區精神病．忽照護各單位權責分工表- 82
附錄四社區精神病．忽或疑似精神病．忽緊急送醫作業流程圖二- 85
附錄五表2 一3 我國與加拿大卑詩省之精神衛生法的比較註解二-86
附錄六衛生著公共衛生護士精神病．忽照護分級照護表-88
附錄七研究問卷-90

參考文獻
一、中文
內政部（2006 ）。內政統計通報。台北：行政院內政部。
王富強（2002 ）。精神鑑定。國立政治大學法律研究所碩士論文。台北：國立政治大學。
台灣護理學會社區護理委員會編（2005 ）。社區衛生護理專業範疇與專業人員職責規範手冊。台北市：台灣護理學會，42 一43 。
毛家船、張玨（1996 ）。護理倫理困窘與護理決策過程。護理雜誌43 ( 1 ) , 40 一45 。
李文暄、葉英瑩（1999 ）。我國社區精神醫療三十年回顧。台北市立療養院八十八年年報。
李明濱（1997 ）。病人自主與知情同意，醫學教育1 ( 4 ) , 377 一388 。
李俊穎、周煌智（2003 ）。從精神病患住院實例探討精神衛生法強制就醫權疑義。醫事法學，10 ( 3 ) , 42 一49 。
叮野朔（1991 ）。精神醫療中患者、治療者問之法律關係。醫事法學4 ( 1 ) , 42 。
邱淑貞（2002 ）。精神科護理的法律與倫理觀• 於王美業總校閱。精神科護理學（PP . 238 一268 ）。台北：五南。
邱淑貞（2003 ）。社區心理衛生• 於陳靜敏總校閱。社區護理學（PP. 238 一268 ）。台北：五南。
何海（2006 ）。精神衛生法有關強制住院部分一加拿大卑詩省與我國精神衛生法之比較。精神醫學通訊，25 ( 12 ) , 355 一356 。
吳育昇（2005 ）。質詢內容。立法院公報，94 ( 22 ) , 327 。
吳麗芬、曾珍麗（1999 ）。社區精神護理持續性護理的現況及展望。護理雜誌，52 ( 1 ) , 11 一17 。
林靜蘭、蕭淑貞、黃宣宜（2005 ）。社區精神護理持續性護理的現況及展望。護理雜誌，52 ( 1 ) , 11 一17 。
馬景野（2000 ）。精神科醫師對精神疾病患者拒絕治療的醫療處理原則研究初探一以精神科專科醫師意見為例。中國醫藥學院醫務管理研究所碩士論文。台中：中國醫藥學院。
黃進興（2003 ）。精神病患醫療人權之研究。國立中正大學法律研究所碩士論文。嘉義：國立中正大學。
彭美琪、許銘（2006 ）。建構社區精神病患照護炯一以台北縣為例。長期照護遑雜誌10 ( 4 ) , 323 一332 。
陸端玲（1998 ）。鄉村型社區慢性精神病患心理衛生需求之探討。國立陽明大學碩士論文，台北：國立陽明大學。
陳乃菁（2002 ）。台灣精神分裂症患者人權堪憂。新台灣新闆週刊3 16 , 69 一75 。
陳甘味、邵文娟、林淑妹（1994 ）。公共衛生護士擔任精神病患保護人之現況分析。八十三年度行政院衛生著委託研究計劃，台北行政院衛生著。
陳美碧（1994 ）。臺北市北區慢性精神病患心理衛生需求之探討。國立陽明大學碩士論文，台北國立陽明大學。
陳淑芬（2005 ）。衛生著中部辦公室心理衛生小組專員。
許蓉零、張玨（1995 ）。精神疾病相關人員對精神衛生法強制護送鑑定與住院治療規定之態度。中華心理衛生學刊，8 ( 2 ) , 45 一58 。
張文英、曾櫻枝、蕭妃秀、王美業（2003 ）。臺東山地鄉公共衛生護理人員在職教育的需求與阻礙。護理研究，n ( 4 ) , 295 一302 。
張玨薛端、許蓉零（1996 ）。疑似嚴重精神病患住院過程之探討。中華心理衛生學刊，8 ( 5 ) , 426 一437 。
元（2006 ）。精神醫療炯計畫未來功能與展望。行政院衛生著、玉里榮民醫院主辦：95 年度全國精神醫療網會議，花蓮。
簡錦標（1991 ）。辦台灣地區精神醫療炯第一期五年計畫成效檢討。台北市立療養院民國八十年年報。
劉蓉台（1999 ）。社區精神醫療保健工作計畫簡介。台北市立療養院主辦：八十八年度台北地區精神醫療網工作計畫之精神障礙者個案管理進興研習講義。
賴貞蘭（1996 ）。精神疾病嚴重病人強制送醫利用之影響因素探討。國立陽明大學碩士論文。台北：國立陽明大學。
楊添圍（2006 ）。簡介美國加州之強制住院。精神醫學通訊，25 ( 12 ) 357 一359 。
戴傳文（1997 ）。我國精神衛生工作的發展。護理雜誌，45 ( 1 ) , 5 一11 。Anderson, 3. & Eppard 3. (1995). Clinical decision making during ssessment for involuntary psychiatric admission. Psychiatric Services 46, 727-728.
Bagby, it, Thompson, 3.5., Dickens S.E. & Nohara M. (1991) Decision making in psychiatric civil commitment: an experimental analysis. American Journal ofPsychiat,y 148,28-33.
Bandura, A.(1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84,191-215.
Bandura, A.(1986). Social foundations of thought and action: A social cognitive theory Englewood Cliffs, NJ: Prentice Hall.
Breakey,W.R.(1995). Integrated mental health service: modern community psychiatric. N. Y. : Oxford University Press.
Clark, N. & Bowers, L. (2000). Psychiatric nursing and compulsory psychiatric care. Journal of advance nursing, 31(2), 389-394.
Cozzareffi, C.(1993). Personality and self-efficacy as predictors of coping with abortion. Journal of Personality and Social Psychology, 65, 1224-1236.
Davis,AJ.,Aroskar,M.A.,Liaschenko,Land Drought,T.S. .(1997) Ethical dilemmas nursing practice. (4th ed.).Appleton&Lange.
Dickey, B., Normand, SI., Hermann, R.C., Eisen, S.V., Cortes, DR., Cleary, PD., & Ware, N. (2003). Guideline recommendations for treatment of schizophrenia: the impact of managed care. Archives of General Psychiatry, 60(4), 340-348.
Edwards D., Burnard P., Coyle D., Fothergill A., Hannigan B. (2000). Stress and burnout in community health nurisng: a review of the literature. Journal of Psychiatric and Mental Health Nursing, 7, 7¡X14.
Fred Luthans(2 002). Positive organizational behavior: Developing and managing psychological strengths. Academy of management executive, Vol. 16,No. 1
Hattori, I. & Higashi, T. (2004). Socioeconomic and familial factors in the involuntary hospitalization of patients with schizophrenia. Psychiatry and clinical neurosciences, 58, 8¡X15.
Herrtz,J.E,Irvin ¡¥ B.L ,& Cheng ¡¥ (1996,10 , ).Theory-based practice: An Introduction to modeling and role-modeling theory. - ¡¥ i¡¦,modeling and role-modelingf Ishizuka, C.,Nakatani, Y., Morita N. & Satoh 5. (2001). Sociodemographic and clinical characteristics of psychiatric patients coercively brought to hospitals. Psychiatry and clinical neurosciences, 55, 147¡X156.
Johansson I. M. & Lundman B. (2002). Patients¡¦ experience of involuntary psychiatric care: good opportunities and great losses. Journal of psychiatric and mental health nursing, 9, 639¡X647.
Lauber, C., Nordt, C., Falcato, L. & Rossler (2004). Public attitude to admission of mentally ill people. Acta psychiatry scand, 105,
385-389.
Lind, M., Kaltiala-Heino, R., Suominen, T., Leino-Kilpihl. & Valimaki M. (2004). Nurses¡¦ ethical perceptions about coercion. Journal of 73
psychiatric and mental health nursing, 1], 379¡X385.
Lodahl, T. M., & Kejner, M. (1965). The Definition and Measurement ofJob Involvement. Journal of Applied Psychology, 49, 24-33.
Kanungo, R. N. (1979).The Concepts of Alienation and Involvement Revisited. Psychological Bulletin, 86(1), pp.119-138.
Kanungo, R. N.(1982).Measurement of Job and Work Involvement. Journal of Applied Psychology, 67(3), pp.34 1-349.
Maragos-Frost, S. & Wells, D. (2000). Psychiatric nurses¡¦ thoughts and feelings about restraint use: a decision dilemma. Journal of advanced nursing, 31(2), 362-369.
McKenna, B. G., Simpson, A. I. F. & Coverdale, J. H. (2000). What is the role of procedural justice in civil commitment? Australian and New Zealand journal ofpsych iatry, 34, 671¡X676.
O¡¦Brien, A. J., & Golding, C. G. (2003). Coercion in mental healthcare: the principle of least coercivecare. Journal of psychiatric and mental health nursing, 10, 167¡X173.
Olofsson, B., & Jacobsson, L. (2001). A plea for respect: involuntarily hospitalized psychiatric patients¡¦ narratives about being subjected to coercion. Journal of psychiatric and mental health nursing, 8, 357¡X366.
Olofsson, B., & Norberg, A. (2001). Experiences of coercion in psychiatric care as narrated by patient, nurses and physicians. Journal of advanced nursing, 3 3(1), 89¡X97.
Olsen, D. P. (2003). Influence and coercion: relational and rights-based ethical approaches to forced psychiatric treatment. Journal of psychiatric and mental health nursing, 10, 705¡X712.
Penticuff,J.H. (1998) .Defining futility in neonatal intenive care. The Nursing Clinics of North America, 33(2 ),3 39-352 ,sauders.
Poulsen,H.D., & Engberg, M. (2001). Validation of psychiatric patients¡¦ statements. Acta Psychiatr Scand, 103, 60-65.
Ramsey,R.,Lassk,F.G, & Marshall,GW. (1995) .A Critical Evaluation of a Measure of Job Involvement:The Use of the Lodahl and Kejner (1965 ).Scale with Salespeople. Journal of Personal Selling&Sales
Ivlanagement,15 (3) .65-74.
Sadock,B.J. & Sadock, V. A. (2003). Kaplan & Sadock¡¦s synopsis of psychiatry: behavioral sciences and clinical psychiatry. Philadelphia: Lippincott Willians & Wilkins.
Salize, H. J., & Dressing, H. (2004). Epidemiology of involuntary placement of mentally ill people across the European Union. British journal ofpsychiatry, 184, 163-168.
Szmukler, G. (1999). Ethics in community psychiatry. Australian and New Zealand journal ofpsych iatry, 33, 328-338..
Wilkinson,J.M. (1988) .Moral distress in nursing practice: experience and effect.Nursing Forum, 23(1), 19-29.