台灣精神衛生護理的展望──復元觀點之再思

The Development of Psychiatric and Mental Health Nursing in Taiwan: Reflection From the Perspective of Recovery

隨著護理科學知識的發展，精神復元、夥伴關係和藥物依循的概念，影響精神衛生護理的發展。本文從精神疾病個案的復元觀點，探究精神疾病個案與照護者間之夥伴關係，建立個案為中心與藥物依循模式。從醫療模式、復健模式，到以病人為核心的賦權模式的演進過程；轉變成為協助個案了解自己的狀況，激發其改變的動機，與發展個案所需的因應技巧之賦權觀念。也因醫療的進步，在第二代抗精神藥物的療效與副作用下， 邀請病人參與藥物開立的決策。另以個案需要為中心的服務觀點，精神衛生的專業人員也修正過去的治療性人際關係，逐漸成為夥伴關係。最後以個案需要為出發點，兼顧個案與照護者間相互需要之概念，作者再思精神疾病個案的照護，翻轉過去醫療專業主導的思維，重新尋找台灣精神衛生護理的未來發展方向。

Evidence-based nursing science has identified psychological recovery, partnership, and medication adherence as factors that have influenced the development of mental health care. This article discusses the process by which mental health care has developed from a medical / rehabilitation-focused model to a model that focuses on patient empowerment. The current model aims to assist patients to achieve self-awareness and to develop coping skills that enhance their motivation to transform. Medical advances have improved the control of psychiatric symptoms. Following the introduction of 2nd generation antipsychotics, patients were invited to establish decisions related to these prescription medications. Under the principles of patient-centered service, Taiwanese mental health professionals have changed their relationship with patients from a therapeutic model to a mutual-partnership model. Furthermore, investigations of the therapeutic care of patients with mental illness have used the needs of patients as their starting point and emphasized various aspects of patient and caregiver needs. Taiwanese mental health professionals are searching for a model of mental health care that is superior to the traditional operative framework of medical authority.