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| 題名: | 精神障礙者家屬參與醫療決策現象分析 |
| 其他題名: | The phenomenon analysis of medical decision-making by psychotic family care |
| 作者: | 李松泰
Li, Sung-tai |
| 貢獻者: | 非營利事業管理學系
鄭文輝
Wen-hui Cheng |
| 關鍵詞: | 社區精神醫療;醫療決策;精神分裂症;充權;照顧者
caregiver;empowerment;Community mental health;schizophrenia;medical decision-making |
| 日期: | 2013 |
| 上傳時間: | 2014-12-31 16:10:17 (UTC+8) |
| 摘要: | 隨著我國精神醫療逐漸走向去機構化，可預見未來病友治療會以社區照護為主軸，社會大眾與醫療互動頻率必然增加。尤以照顧者和社區居民將直接面對此醫療模式轉變的衝擊，在未來擔負起更多社區照護履行者角色。但在過往長期被專業所忽略的家屬角色以及醫病關係緊張、衝突等諸多不確定性因素影響下，後續實有協助醫用雙方建構一個穩定醫療決策平台，以促使體系中所有相關專業與機構均能發揮應有功能。 本研究以參與觀察以及個別深入訪談的方法，分別蒐集6次門診觀察紀錄加上8位醫事人員以及6位照顧者的照顧經驗，透過觀察以及訪談，來了解病情世界與醫療世界在面臨醫療決策時，是如何考量醫用互動和病友醫療自主權、如何平衡社區整體和病友的個人需求、以及如何因應現醫療政策，進而找到彼此適切位置及對話管道，滿足彼此的需求等。 主要的研究發現有四項：（一）社區精神醫療模式，使社區居民有機會全程參與療程，從實際接觸消除對疾病的恐懼和偏見。（二）病友抗拒治療因素除藥物副作用及污名化等影響外，病友個人社會角色被剝奪恐懼可能也是抗拒治療原因之一。（三）家屬有無參加自助性團體，明顯影響病友發病後的求醫類型。（四）精神醫療仍然受到知識權力不對等及醫療政策影響，使家屬決定權與病友自主權無法兼顧。 依據上述研究發現，本研究提出以下幾點建議：（一）營造家屬自助性團體運作環境，保障病家醫療權益。（二）明確制定家屬照護規範，提升治療穩定性。（三）建構精障個管師服務平台，提供資源整合服務。（四）將病友及照顧者納入長照保險體系，有效抒解照顧負荷。
Along with Taiwan’s mental care has become deinstitutionalization, we can foresee that community care will be the mainstream of the treatment, and that the interactions between the mass population and the medical agencies will increase inevitably. The caregivers and the community will face the impact of the changing of the medical model, and that they will have to take charge of the caring role in the future. There are many uncertain factors that will influence the corporations , such as the role of the patient’s family that has been neglected for a long time, and the conflictual and intense physician-patient relationship. In order to have better corporations, to assist both sides to construct a stable medical decision-making platform is really in need. This research use the methods of participating in the observation and the individual in-depth interview, collecting 6 outpatient observation records, to add on 8 medical personnel and 6 caregiver's attendance experiences separately. By observation and interviewing, the researcher collected some information to answer the following questions. The first one is how they balance the medical interaction and the patients’ autonomy while facing medical decisions. The second one is how to balances the rights of community and the patient's individual demand. The third one is how to cope with the present medical policies. So that they can find the appropriate positions to communicate and to meet each other’s demands. The main research discovered that, 1.Community psychiatric rehabilitation model, enable the communities to participate in the treatment, and to eliminate the fear and the prejudice through actual contact, 2. The reasons of patients resisting the treatment are not only the drugs side effect and stigmatization, but also the fear of the deprivation of their social roles. 3. Family members participate in the self-help group or not would affect the ways they seek help when needed. 4. Due to the knowledge gap and the medical policy, the families’ decision right and the patients’ autonomy can’t be balanced. According to this research and conclusion, I bring out the following suggestions: (一) Having more self-help group to safeguard the medical rights of patients and families.(二) Setting norms about the participation of the family members in the community caring system.(三) Setting mental disorders case manager service platform, to provide integration services.(四) Adding the psychotics and their caregivers into the long-term caring system. |
| 顯示於類別: | [企業管理學系(管理科學碩/博士班,非營利事業管理碩士班)] 博碩士論文-非營利事業管理碩士班
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