身心障礙機構住民皮膚問題之改善方案

Improvement Program for Residents with Skin Problems in Physical and Mental Disability Institutions

前言：皮膚疾病為身障機構住民常見的健康問題之一，智能障礙者為皮膚性疾病的高危險群其罹患一種甚至合併多種的皮膚性疾病亦為機構中住民的普遍現象。機構團體生活型態與欠缺皮膚問題改善之策略是無法降低皮膚疾病罹患率的主因，國內研究較多涉及疾病類型與感染率等議題的探討，而針對「改善方案」則鮮少相關研究。本研究之目的在於探討身心障礙機構實施「皮膚問題改善方案」之過程與效果。執行期間為2009年至2016年持續八年，該機構參與者共為97位重度或極重度心智障礙者，男生有63位（65%），女生有34位（35%）。41.2%為智能障礙，49.5%為多重障礙，7.2%為自閉症，2.1%為肢體障礙者。本方案主要以皮膚檢測及門診醫療搭配皮膚照護等方式之介入，採取定期進行皮膚檢測、提供每週兩次醫療門診且依據門診處方給予日常皮膚照護等方式著手。研究方法：採用質性研究訪談七位參與本方案之護理人員與教保人員以評估本措施之執行過程。結果：身障者因口語與智能障礙其反映皮膚問題的能力薄弱、欠缺衛生觀念為導致皮膚問題的主因，在群居生活中個人用品的區隔困難及智障者衛生習慣養成不易，為改善皮膚問題最大的困難；加強個人衛生教育、保持皮膚清潔滋潤、落實醫療照護療程為改善皮膚問題的關鍵。結論與建議：本研究顯示本方案對於機構住民皮膚問題改善有正面幫助且參與者均表示肯定，所彙整的皮膚問題改善策略模型歸納出本方案執行階段的關鍵因素，可作為身障機構之參考。

Skin disease is one of the most common health issues among residents in disability institutions. The mentally disabled are a high-risk group of residents in these institutions, and this group commonly contracts one to many types of skin disease. A group-centric lifestyle and a lack of a strategy to alleviate skin problems is the main reason skin diseases are unable to decrease. Domestic research is mostly on topics concerning disease types and infection rate, but few are related to the topic of improvement Programs. The purpose of this research is to review the process and effectiveness of the Skin Problem Improvement Plan implemented in a physical and mental disability institution. The period of implementation was 8 years, from 2009 to 2016. There were 97 participants with severe or extreme-severe mental retardation, of whom 63 were men (65%) and 34 were women (35%). A total of 41.2% of the participants suffered from mental retardation disorder, 49.5% from multiple disorders, 7.2% from autism, and 2.1% from physical disabilities. This program consisted of skin examinations and outpatient medical skin care and other means of treatment. Regular skin examinations as well as 2 visits per week to the clinic were provided, and daily treatment followed as per each examination required. Research method: qualitative research by conducting interviews on 7 participants who were medical and teaching staff in order to assess the process of implementation. Results: Skin problems occur mainly because the disabled suffer from oral and mental barriers which weaken their ability to reflect on skin problems and understand the need for good hygiene. Furthermore, a group-centric lifestyle that poses as a barrier to setting aside personal-hygiene items and the difficulty for the disabled to develop hygiene habits are factors that contribute to the difficulty of alleviating skin problems. Reinforcing personal-hygiene education, maintaining clean and moisturized skin, and implementing medical treatment are main factors that can alleviate skin problems. Conclusion and Suggestions: This research has shown the program’s positive contribution to the improvement of skin problems in residents of disability institutions and has also seen approval by the participants. Through consolidating the strategic model for skin-problem improvement, this research suggests key factors during each phase of the implementation of this program, to which disability institutions can refer.