中高齡女性思覺失調症患者照顧議題:一個個案研究

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Title:	中高齡女性思覺失調症患者照顧議題:一個個案研究
Other Titles:	The Care Issue of Elderly Woman with Schizophrenia:A Case Study
Authors:	黃雅音 HUANG,YA-YIN
Contributors:	劉珠利 LIU,CHU-LI 社會工作學系
Keywords:	中高齡女性思覺失調症患者;照顧 elderly woman with schizophrenia;care issue
Date:	2016
Issue Date:	2016-10-20T08:15:59Z (UTC)
Abstract:	中高齡之思覺失調症患者人數近年日漸增加，日益成為思覺失調症患者之大宗。其認知、溝通、交通、經濟管控、參與活動、整理家務以及建立友誼能力明顯地低落，社會支持網絡與情感性支持相較之下顯得不足；加上因為性別因素造成疾病好發期、疾病之症狀表現、藥物引起的副作用及其後續醫療併發症的問題，對中高齡女性思覺失調症患者產生了有別於一般思覺失調症患者之影響，在面對社區照顧資源不足，家中原本照顧者角色功能式微之時，照顧責任無人可承擔與負荷之際，其照顧問題勢必油然而生。本研究針對一個中高齡思覺失調症未婚女性之照顧議題進行個案研究。研究發現如下：一、讓親屬願意承擔照顧責任的推力包含：1.情感因素-(1)源於同情、(2)出於疼愛、(3)感同身受、(4)放不下的擔心；2.其背後所持的信念包含：(1)忠於多年前的託付、(2)認為自身為家族長輩需擔負照顧晚輩之責任、(3)只是多一副碗筷而已、(4)過來人幫助過來人。另外3.宗教信仰的教導、4.患病時日漫長，其他親屬不願再承擔照顧責任也是促使親屬願意擔負照顧責任之推力；二、阻抗親屬擔起照顧責任的拉力則包含：1.照顧上遇到挑戰-(1)長期以來反覆地面對不受拘束、脫序的行為、(2)行為影響鄰舍、(3)長期需要24小時隨侍在側、2.心有餘力不足-(1)身體不堪照顧之負荷、(2)無法長期負擔醫療費與生活費、(3)因照顧而衍生家庭衝突，3.阻抗期擔負照顧責任之背後所持之信念則是-(1)願意短期協助救急，不願長期投入照顧、(2)時間遷移，親屬們各自有家庭與生活要顧；三、長期在推力與拉力兩者拉扯的過程中所產生的情緒包含：1.因患者症狀所帶來混亂的情緒、2.面臨處置抉擇兩難的困惑感、3.覺得似乎幫不上忙的內疚感；以及4.親屬在分擔責任過程中產生了(1)憤恨不平、(2)痛苦、(3)傷心失望與(4)難過的情緒。四、親屬所發展的因應策略包含：1.行為上(1)無法長期往返協助照顧患者之親屬選擇金錢與物質上的資助、(2)原有照顧者不堪長期照顧負荷選擇脫離原有照顧之列、(3)長期擔負主要照顧責任之親屬改變照顧之模式(A)不給予金錢改以提供物資與伙食、(B)從長期照顧過程中發展順應與安撫的策略；2.感知上的因應策略則包含(1)相互鼓勵、(2)賦予意義、(3)持守希望；3.資源上的因應策略包含(1)透過鄰居尋求協助、(2)尋求社會資源之協助、(3)尋求宗教信仰之支持。五、適應的結果是，1.主要擔負照顧責任之親屬透過暫時卸下照顧責任，得以維持家庭之完整性與個人之獨立性、2.患者得以透過復健促進個人之發展，手足也可以展開屬於自己獨立的生活。最後本研究分別在社會工作基礎教育、實務執行層面、政策規劃以及未來研究上提出建議。 Elderly patients with schizophrenia keep increasing among adults in recently years and become major group. Perception, Communication, traffic, economic control, active participation, housekeeping and social skills are significant lower than people without schizophrenia, and it shows insufficient from social supporting network and emotional supporting versus others. Additional problems from sex factor caused sickness occur-rence, symptom representation, side effect from medicine and complication from medi-cal care, creates different effects to elderly woman with schizophrenia from adult pa-tients with schizophrenia. Care problem certainly will be increasing while face insuffi-cient community care resources, original family caregiver function decreasing, no peo-ple could take the responsibility and loading of care. This research used a case study regarding to the care issue of elderly unmarried woman with schizophrenia. Study found 1.the pushing force let relative willing to take care responsibility includes: (1). Emotion factor- from (A) sympathy, (B) love, (C) feel same with patient, (D) no-ending worry. (2). The faith behinds include: (A) loyal to care commit for years, (B) self-recognize an elder have to take responsibility of caring junior generation, (C) just a little keeping, (D) an experienced people to help. In addition, (3). guidance of religion faith, (4) take times sickness, other relative not willing to care also a pushing force let relative willing to take care responsibility. 2.Pulling force against relative take care responsibility include: (1) Challenge from caring – (A) repeatedly facing unrestrained in longer term, disorder activities, (B) affect neighborhood, (C) 24 hours stand by in longer term. (2) Mentally and physically ex-hausted – (A) physical tired of care loading, (B) no longer carrying the expense of medical and living, (C) confliction among family members from caring. (3) The faith behinds take caring during confliction period were – (A) willing for short term urgency helping instead long term caring, (B) time passing, relatives have their own family and life to worry. 3.Emotions from long team confliction among pushing and pulling course include: (1) Confusion emotion from patient symptom, (2) perplexity from face treatment choice difficulty, (3) guilty conscience from helpless feel. (4) It easy to come emotions of (A) resentment, (B) paint, (C) grieved, disappointed and (D) sad from relative share respon-sibility course.4.The coping strategies developed by relative during this period include: (1)Behavior – (A) choose economic and substance supporting from those relative not able to travel and fro to help care patient in long period, (B) choose depart from caring patient for those original caregiver with physical tired of care loading, (C) change care type from those take long period main caring relative (a) giving substance and meals instead money, (b) develop orientated and pacified strategy from long period caring. (2) Percep-tion coping strategies includes: (A) encourage each other, (B) put a construction, (C) keeping hope. (3) Resources coping strategies includes: (A) seeking support from neighbor, (B) seeking support from social resources, (C) seeking support from religion faith. 5.The Result of adaption are (1) main caregiver could maintain family integration and personal independence through temporary depart from caring responsibility；(2) patient could promote personal development through community rehabilitation programs, sib-lings could expand their own life. This study recommends to social work foundation education, professional worker, general medical care and future study.
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