具暴力行為的精神分裂症病人照顧負荷及其影響因素

Violent Schizophrenia Patients: Caregiver Burden and Related Factors

背景：精神病人的暴力行為，不但是社會大眾對病人的重要社會烙印，更是家屬最切身之痛及照顧負荷的最大來源。目的：探討家屬面對精神分裂症病人暴力行為之照顧負荷。方法：採橫斷面研究，立意取樣選取北市某精神專科醫院，有暴力行為史之精神分裂症病人的主要照顧者共100位進行研究。問卷包括樣本屬性、因應方式量表、照顧者負荷量表。結果：平均總照顧負荷為30.8分，屬於中度負荷。影響照顧負荷的因素為病人職業、照顧者教育程度、情緒處理及認知壓抑因應方式、病人的暴力行為。運用多元迴歸分析顯示，「情緒處理因應方式」、「病人對主要照顧者出現暴力行為」是照顧負荷的重要影響因子。結論／實務應用：本研究結果顯示，當病人對主要照顧者出現暴力行為且照顧者較常採用壓抑等負向情緒因應時，則其負荷感受相對較重。建議護理人員應主動評估與瞭解家屬面對病人暴力行為時所採取的因應方式，並協助照顧者發展及採用實際有效的方式來因應病人的暴力行為，以減輕照顧負荷。

Background: Schizophrenia-related violent behavior is a social stigma borne by schizophrenic patients and a highlypainful burden faced by caregivers.Purpose: This study focused on how primary caregivers deal with schizophrenic patient violent behavior and factorsthat affect this burden.Methods: Researchers recruited a purposive sample from the acute wards of a psychiatric hospital in Taipei city.This cross-sectional study studied 100 primary caregivers of schizophrenic patients with a history of violent behavior.Socio-demographic data were collected using structured questionnaires on coping methods and caregiver burden.Results: Results found an average primary caregiver burden score of 30.8 points, indicating a moderate degree of burden.Factors contributing to the total care burden were: patient occupation, caregiver level of education, emotional copingmethod, negative cognitive coping method and violent behavior type. After multiple regression analysis, the twosignificant factors affecting caregiver burden were identified as: Emotional coping method and violent behavior type.Conclusions / Implications for Practice: This study highlighted a higher burden in violent schizophrenic patientcaregivers who use emotional coping methods. Researchers recommended that clinical staff voluntarily assess caregiverburdens and methods of coping with patients' violent behavior in order to help caregivers develop specific andefficient coping strategies to reduce care burden.