以行動研究法推展醫院住院病人的自殺防治作業與自殺照護

An Action Research: To Promote Suicide Prevention and the Care of Inpatients

目的：以行動研究法推展醫院住院病人之自殺防治作業，增進臨床醫護人員自殺防治知能，提昇住院病人自殺高風險之通報率，以降低自殺發生率。方法：本研究採行動研究法，自2013年6月至2014年12月，於中部某區域教學醫院，依行動研究中診斷問題、選擇方案、尋求合作、執行實施、評鑑反應五步驟循環歷程進行；運用醫院內部及外部相關專業資源、透過三次焦點團體、舉辦三次自殺防治之教育訓練課程等措施，連結院內自殺防治小組，持續探討住院病人自殺防治相關問題並進行建議與改善。結果：本研究經由跨團隊合作，修正住院病人自殺防治作業流程，包含自殺高風險個案通報方式由護理人員提醒主治醫師改為資訊系統自動通知、擴大適用高風險個案由六項增至八項、修改自殺通報標準，由BSRS-5總分大於等於10分提高至15分，與醫院自殺防治作業執行檢討，以及提昇醫護團隊自殺照護知能等；2012-2014年住院自殺高風險個案通報率由0％上升至76％，自傷自殺發生率由0.0039％降至0.0014％，死亡率0％。結果顯示，透過住院病人自殺高風險評估，能有效提昇高風險個案通報，降低自傷自殺之發生。結論：建置住院病人自殺防治作業，團隊成員不但能落實提升高風險個案評估與通報，並能有效降低自殺未遂案件，落實病人安全，盼能提供臨床實務應用之參考。

Purposes: The aim of the study is to promote suicide prevention and the care of inpatients using action research, to build an appropriate mechanism for suicide prevention, promote the suicide prevention ability of clinical staff, enhance the informed rate for risk patients, and reduce the incidence of inpatient suicides. Methods: This action research was performed between June, 2013 and December, 2014 in a regional teaching hospital in central Taiwan. The study consisted of five circulative stages: problem diagnosis, action plan design, seeking collaboration, plan/ implementation, and outcome evaluation. Linking internal and external resources, there were three focus group interviews and three in-service education, with participants continuing the discussion on suicide prevention issues and translating knowledge into action to improve operations. Results: An implementation of cross-disciplinary teamwork project, modifying the inpatient suicide prevention processes, suicide prevention notification shift to computer operations, extension of the application of high-risk cases from six to eight items. Changes to the notification score from 10 to 15; the case notification rates increases from 0 % to 76%, suicidal and self-harming rate dropped from 0.0039% to 0.0014% in 2014. Conclusions: Using analytical and reflective techniques that translate knowledge into action to build an appropriate mechanism for inpatient suicide prevention, this research can provide a referenced application for clinical practice.