不同就醫模式精神病患的家庭照顧者照顧負荷之研究：以南部某區域教學醫院為例

A Study of Caregiver Burden in Family Caregivers of Psychiatric Patients With Different Medical Behaviors at a Regional Hospital in Southern Taiwan

目的：隨著精神醫療的革新，當病患走出醫院，如何銜接完善的照護系統，成為目前病患照護重要議題之一。因此，本研究擬比較三種不同就醫模式下精神病患家庭照顧者負荷、家庭功能與社會支持之差異。方法：本研究採橫斷式設計，以南部某區域醫院門診、急性精神科病房及日間病房精神病患三類之家庭照顧者為收案對象，收案時間為2020年3月至2020年6月，共招募74位。問卷以面訪方式進行，問卷內容含基本資料表、家庭功能量表、照顧者負荷量表及社會支持網絡量表。結果：三種精神病患之家庭照顧者人數分別為門診32位、急性病房23位、日間病房19位。結果顯示，三種不同就醫模式下的精神病患之家庭功能中的溝通、情緒與規範功能呈現顯著差異；家庭照顧者負荷之烙印、照顧者緊張感與總分呈現顯著差異；社會支持則是在親近關係上呈現顯著差異。結論：臺灣保守的社會風氣，使精神病患照顧者因精神疾病汙名化，鮮少與外界互動，照顧者的身心狀態未被重視。在接觸許多家庭照顧者後，發現應加強家庭照顧者疾病認知及照顧，針對病患個別性提供持續性照顧及復健安排，且需適時地轉介社區復健機構協助，幫助病患與社會接軌。

Purpose: With the innovation of psychiatric care, how to connect to a comprehensive care system after patients are discharged from the hospital has become an important issue in patient care. Therefore, this study was designed to compare the differences in the burden on family caregivers, family functioning, and social support among psychiatric patients in three different models of medical care. Methods: This study adopted a cross-sectional design and targeted three categories of family caregivers of psychiatric patients in outpatient, acute psychiatric wards and day wards in a southern district hospital. A total of 74 patients were recruited from March 2020 to June 2020. The questionnaires were administered by personal interview. The questionnaires included the Basic Information Form, the Family Functioning Scale, the Caregiver Burden Scale, and the Social Support Network Scale. Results: The number of family caregivers for the three types of psychiatric patients was 32 in the outpatient clinic, 23 in the acute ward, and 19 in the day ward. The results showed that there were significant differences among the family functioning of communication, emotion and normative functions of the three different modes of psychiatric care. Significant differences were found in the stigma family caregivers burden, the stress of caregiver, and total score. A significant difference was found in social support in terms of close relationships. Conclusions: Taiwan is a conservative society. As a result of caring for psychiatric patients, the caregivers suffer from stigmatization and rarely interact with the outside world. The physical and mental state of the caregivers have not been taken seriously. After interviewing many family caregivers, it is found that family caregivers’ awareness of the illness and care strategies should be strengthened. Ongoing care and rehabilitation arrangements should be tailored to the individual patient. Timely referrals to community rehabilitation agencies are needed to help patients integrate into the community.