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研究生:劉欣怡
研究生(外文):LIU, HSIN-I
論文名稱:「疾病管理與復元方案」對躁鬱症病人成效之研究
論文名稱(外文):Illness Management and Recovery program for the effectiveness of patients with bipolar disorder
指導教授:蔡欣玲蔡欣玲引用關係
口試委員:陳宗泰鄭淑利
口試日期:2019-05-28
學位類別:碩士
校院名稱:輔仁大學
系所名稱:護理學系碩士班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:97
中文關鍵詞:躁鬱症疾病管理與復元
外文關鍵詞:bipolar disorderRecoveryIllness Management
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中文摘要
背景:躁鬱症屬慢性化、高度復發率及症狀不穩定之嚴重精神疾病,對社會構成巨大的經濟負擔。實證研究支持疾病管理與復元方案,可促進躁鬱症病人疾病管理知識與因應症狀,進而達到復元目標。

目的:此研究在發展以門診躁鬱症病人為對象,檢視該族群病人運用疾病管理與復元方案介入後之疾病管理及復元的成效。

方法:研究採實驗雙組前、後測之設計,研究對象取自北部某醫學中心門診躁鬱症病人,使用隨機分配方式,收案樣本為84人,分成實驗組及對照組各42人,實驗組每週二次,為期五週,每次60分鐘,共十次課程,接受疾病管理與復元團體方案介入,對照組則一般常規治療。研究工具包括:「個人基本屬性」、「疾病管理與復元量表」、「精神疾病復元程度表」進行前後測資料收集。以SPSS 23.0軟體進行統計分析,以描述性統計包含平均值(Mean)及標準差(SD)描述連續變項,次數分配及百分比:以個數(n)及百分比(%)呈現類別變項分布情形,而推論性統計以卡方檢定(Chi-square test)、成對樣本t檢定(Paired t test)分析。

結果:(一)在疾病管理上:疾病知識、有效地使用藥物兩方面均有進展,疾病管理的總平均分數達統計上顯著差異(P值<0.001),且實驗組總分高於對照組。總括來說,復元團體方案介入後對於躁鬱症病人在「疾病管理」上確實有成效,且能夠加強成員自我的疾病管理之能力。(二)在精神疾病復元程度上:在護理人員評分方面,針對護理人員評分在思考、現實感測試、遵囑治療、面部表情、語言、對他人感興趣、個人衛生、社交互動技巧、維護自我權益九部分,達統計上顯著差異(p值<0.05),顯示實驗組病人在疾病管理與復元方案介入對疾病復元程度有顯著的提升。在病人評分方面,針對病人評分在思考、現實感測試、個人衛生、社交互動技巧、維護自我權益五部分,達統計上顯著差異(p值<0.05),顯示實驗組病人在疾病管理與復元方案介入對疾病復元程度有顯著的提升。

結論:本研究探討由護理人員進行疾病管理與復元方案,確實能增加躁鬱症病人對疾病管理知識及提升個人復元能力,可做為護理專業人員將來關於躁鬱症臨床照護參考。

關鍵字:躁鬱症、疾病管理與復元


ABSTRACT

Background:Bipolar disorder is a serious major mental illness with unstable emotional symptoms. It is commonly chronic in nature and at high risk of recurrence, and can cause a huge economic burden on society. Empirical researches indicated that the “Illness Management and Recovery Program” was available to achieve recovery targets for patients with bipolar disorder.

Objective:This study aims to evaluate the effectiveness of the “Illness Management and Recovery Program” in promotion of recovery for patients with bipolar disorder in psychiatric outpatient clinics.

Methods: An experimental two group pre-test and post-test research design was used. Participants included 84 matched experimental and comparison groups in the patients with bipolar disorder from psychiatric outpatient clinics at a medical center in north Taiwan. Forty-two participants in the experimental group participated in a 9-topic (10 hours)will take the “Illness Management and Recovery Program” twice a week for 5 weeks,control group(n=42) in the comparison group did not participate in the educational program.

Result:The difference in total disease management scores was statistically significant (P < 0.001),group The LORS -patient discrepancy data showed a significant treatment effect( (P < 0.05)。

Conclusion:intervention of “Illness Management and Recovery Program” has evident efficiency in both illaess managemen and Recovery.


Keywords:bipolar disorder, Recovery, Illness Management

目錄
第一章 緒論 ........................................................ 1
第一節 研究背景 .................................................. 1
第二節 研究目的 .................................................. 5
第三節 研究假設 .................................................. 6
第二章 文獻查證 .................................................... 7
第一節 躁鬱症的簡介 .............................................. 8
第二節 躁鬱症與復元 ............................................. 11
第三節 疾病管理與復元團體方案介入 ............................... 14
第四節 疾病管理與復元方案相關的實證研究 ......................... 18
第五節 團體教案教學策略 ......................................... 21
第六節 疾病管理與復元之測量 ..................................... 24
第三章 研究方法 ................................................... 27
第一節 研究設計 ................................................. 27
第二節 研究架構 ................................................. 35
第三節 研究對象 ................................................. 37
第四節 研究步驟 ................................................. 39
第五節 研究倫理 ................................................. 40
第六節 資料處理與分析 ........................................... 41
第四章 研究結果 ................................................... 42
第一節 研究對象基本屬性分析 ..................................... 42
第二節 疾病管理與復元方案對躁鬱症病人成效分析 ................... 46
第三節 疾病管理與復元方案對躁鬱症病人差異分析 ................... 47
第四節 團體成員出席狀況分析 ..................................... 50
第五章 討論 ........................................................ 51
第六章 限制與建議 .................................................. 55
第七章 結論 ........................................................ 57
參考文獻 ........................................................... 59
附錄 ............................................................... 66
附錄一 臨床試驗許可書 ............................................ 66
附錄二 受試者研究同意書 .......................................... 67
附錄三 疾病管理與復元量表同意信件 ................................ 74
附錄四 精神疾病復元程度量表同意信件 .............................. 75
附錄五 個案基本屬性表 ............................................ 76
附錄六 疾病管理與復元量表 ........................................ 77
附錄七 精神疾病復元程度量表 ...................................... 80
附錄八 疾病管理與復元團體計劃書 .................................. 81
附錄九 團體紀錄單 ........................ ........................ 93
附錄十 團體集點卡 ................................................ 96
附錄十一 團體活動證書 .............................................. 98
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