臺灣博碩士論文加值系統

目的：嚴重精神疾病需要控制精神症狀並提供持續性照護服務，避免疾病再復發，並促進復元以維持社區生活品質。而精神護理之家住民，面對整體功能及社會支持不足等阻礙復元的劣勢，賦能是否能緩解這些不利因素對精神護理之家住民復元之影響？本研究即探討精神護理之家住民復元之預測因素及賦能所扮演的角色。
研究方法：以橫斷式相關研究設計，採方便取樣。於北部某精神專科醫院附設精神護理之家為研究地點，在2018/04/01-2018/06/01期間，以信效度良好之自填結構式問卷進行資料收集，測量變項有六大項為：1.個案因素（性別、年齡、婚姻、教育程度、庇護性工作、宗教、家庭收入）；2.病況因素（病程時間、住院次數、精神症狀、整體功能）；3.社會支持；4.賦能；5.復元。以IBM SPSS21.0為統計工具，運用描述性統計、單因子變異數分析、皮爾森積差相關及階層複迴歸等方法進行推論性統計分析。
研究結果：精神護理之家住民共158位參與者完成問卷，平均年齡為59.5歲，以男性（50.6%）、未婚（64.6%）者居多，教育程度多數為國中（含）以下（57.6%），每月家庭收入普遍為兩萬（含）以下（70.9%），精神護理之家住民之復元率為53.6%。整體變項中，宗教（t = -2.3）、精神症狀（r = - .29）、整體功能（r = .31）、社會支持（r = .44）、賦能（r = .49）與復元呈顯著相關。階層複迴歸模式下，整體功能(β= .25）、社會支持(β= .28）及賦能(β= .39）能預測復元，整體解釋力達40.8%。在控制個案、病況因素後，賦能對於社會支持與復元間具部分中介效應，間接效果為30%。
結論與建議：精神護理之家住民之復元率僅有一半，整體功能、社會支持及賦能可顯著預測復元，賦能亦扮演重要中介角色，可減緩社會支持對於復元之影響，本研究建議除了改善復元之影響因素外，另可發展以賦能為導向的持續照護方案，比強化整體功能及社會支持對強化精神護理之家住民復元更有正向助益。

Background: Continuous treatment is needed for patients with severe mental illness to prevent relapse, improve recovery and maintain the quality of life in the community. Psychiatric nursing home residents usually have chronic symptoms, functional impairment, and inadequate family support. This study explores the predictive factors of psychiatric nursing home residents on recovery and the role of empowerment.
Methods: This study is cross-sectional design with convenience sampling. Subjects were recruited from a psychiatric nursing home in Northern Taiwan from April to June 2018. Demographics (gender, age, marital status, educational level, occupation, religion and family income), disease status (duration, admission count, psychiatric symptoms and overall function), social support, empowerment and recovery rate were collected by self-report structured questionnaires. IBM SPSS 21.0 is the statistics program used to perform inferential statistical analysis with descriptive statistics, t-test, ANOVA, pearson's correlation and hierarchical regression.
Results: One hundred and fifty-eight patients completed the surveys, with an average age of 59.5 years old. Most of them are male and unmarried. The education level is mostly junior high school (57.6%). The monthly family income is less than 20,000 (70.9%). The psychiatric nursing home resident's recovery rate is 53.6%. Religion (t = -2.3), psychiatric symptoms (r =-.29), overall function (r =.31), social support (r = .44) and empowerment (r = .49) all have significant correlations with recovery. In the hierarchical regression model, overall function (β = .25), social support (β = .28), and empowerment (β = .39) can predict recovery, with the explanatory power reaching 40.8%. After controlling the patients’ disease status, there is a partial mediating effect between empowerment and social support to recovery. The indirect effect is 32%.
Conclusion: Psychiatric nursing home residents only had half of the recovery rate. The overall function, social support and empowerment can significantly predict the recovery. Empowerment can mediate the effect of social support toward recovery. This study recommends that improving the impact factors of recovery as well as developing an empowerment-oriented care program will be more positive for strengthening the psychiatric nursing home residents on recovery.

中文摘要 i
英文摘要 ii
目錄 iii
表次 v
圖次 vi
第一章緒論
第一節研究背景 1
第二節研究重要性 3
第三節研究目的 4
第四節名詞界定 5
第二章文獻探討
第一節精神病人復元定義、要素及測量工具 7
第二節精神護理之家住民復元之影響因素 11
第三節精神護理之家住民整體功能、社會支持、賦能與復元之關係 14
第三章研究方法
第一節研究架構 16
第二節研究假設 17
第三節研究設計 18
第四節研究對象及取樣 19
第五節資料收集程序 20
第六節研究工具與信效度 22
第七節研究倫理考量 25
第八節資料處理與分析 26
第四章研究結果
第一節研究對象個案因素、病況因素、社會支持、賦能及復元之描述 28
第二節個案因素、病況因素、社會支持、賦能與復元之關係 32
第三節個案因素、病況因素、社會支持、賦能對於復元之預測 35
第四節賦能對於社會支持影響復元之中介效果 39
第五章討論
第一節討論精神護理之家住民個案因素、病況因素、社會支持、賦能及復元之現況 43
第二節討論個案因素、病況因素、社會支持、賦能與復元之預測 45
第三節討論賦能對於社會支持影響復元之中介效果 47
第六章結論、限制與建議
第一節結論 48
第二節研究限制 49
第三節應用與建議 50
參考資料
中文部分 51
外文部分 54
附錄
附錄一精神症狀-簡短精神症狀量表BPRS (含授權同意書) 60
附錄二整體功能-整體功能評估表GAF 64
附錄三中文版社會支持問卷NSSQ(含授權同意書) 65
附錄四中文版賦能量表(含授權同意書) 69
附錄五中文版復元問卷QPR (含授權同意書) 71
附錄六人體試驗計畫同意函 74
附錄七研究對象之自填問卷彙整 75
附錄八收案者之評估問卷彙整 82

表　　次
表3-1 研究變項之測量內容……………………………………………… 22
表4-1 精神護理之家住民個案因素、病況因素、社會支持、賦能及復元之現況描述………………………………………………………
30
表4-2 精神護理之家住民個案因素、病況因素、社會支持、賦能及復元之關係描述………………………………………………………..
33
表4-3 精神護理之家住民復元預測因素與復元之階層複迴歸分析……... 38
表4-4 彙整賦能對於社會支持影響復元之效果………………………… 42

圖　　次
圖2-1 搜尋實證文獻之流程圖…………………………………………….. 11
圖3-1 研究架構圖 ……………………………………………………….. 16
圖3-2 資料收集流程圖…………………………………………………….. 21
圖4-1 復元總分之Q-Q圖.……………………………………………… 32
圖4-2 標準化殘差直方圖………………………………………………… 35
圖4-3 標準化殘差P-P圖………………………………………………… 35
圖4-4 殘差散佈圖……………………………………………………….. 36
圖4-5 賦能對於社會支持與復元間的中介路徑圖……………………… 40
圖4-6 賦能對於社會支持-家人與復元間的中介路徑圖………………... 40
圖4-7 賦能對於社會支持-親戚朋友與復元間的中介路徑圖…………... 41
圖4-8 賦能對於社會支持-機構工作人員與復元間的中介路徑圖……... 42

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