吳錦喻臺灣大學：職能治療研究所吳希文Wu, Hsi-WenHsi-WenWu2007-11-272018-07-122007-11-272018-07-122004http://ntur.lib.ntu.edu.tw//handle/246246/55404本研究目的在探討長期收容機構中慢性精神分裂症病患的職能參與經驗，包括病患所從事的職能活動特質、職能參與情形、職能參與和個人健康及安適感間的關係、以及影響病患職能參與的個人因素及環境因素。本研究採紮根理論研究法，研究參與者包括五位男性及一位女性，平均年齡42.4歲，長期收容年數由0.6年到14.3年不等。部分研究參與者接受兩次訪談，總計進行九次訪談。研究結果顯示，研究參與者的職能特質為活動內容缺乏變化、以被動性的活動為主、生活高度群體化、缺少個別活動及隱私；職能參與情形為日常活動的安排高度結構化，但參與態度消極被動，以排遣時間為主；職能參與受到一些個人因素（如：個人的價值觀、對正常化╱退化的覺察等）和環境因素（如：機構制度的限制、家屬支持的低落等）的影響，而這些影響因素的交互作用呈現於研究參與者比較過去與現在的生活經驗後的相對比較結果，比較的結果在經過個人價值觀的調節後對個別收容病患的職能參與產生不同的影響。本研究的結果呼應人—環境—職能模式，支持人類職能表現為個人、環境、及職能活動之動態交織的結果，但本研究結果更具體呈現長期收容的社會文化環境特徵對這群病患的衝擊，以及不同影響因素的交互作用對長期收容病患之職能參與的影響。本研究的發現將有助於精神醫療專業人員對長期收容機構病患之職能參與現象的覺察與瞭解，進而提供實務工作的參考。The purpose of this study was to explore the experiences of occupational participation in persons with chronic schizophrenia who live in a long-stay facility. It investigated the characteristics of occupations performed, how occupations were participated in the facility, any impact on the health and well-being, and factors that influenced occupational participation. The methods of grounded theory were used. Six participants including 5 male and 1 female were interviewed. Their average age was 42.4 years old, and the length of stay in the facility ranged from 0.6 to 14.3 years. Some of the participants were interviewed twice, and in total nine interviews were completed. The results of this study revealed that the characteristics of occupation performed in the long-stay facility was sameness day after day, and was predominantly composed of passive activities. Patients in the facility lived as a group, and there was a lack of individual activities and privacy. The pattern of occupational participation was highly structured. The participation was passive and for killing time. Occupational participation was affected by personal factors such as personal values or the awareness of normalization/deterioration, and environmental factors such as restrictions of institutional rules or lack of family support. Participants’ comparisons of his or her living status before and after admitted into the facility revealed a phenomenon of relative comparison, which affected occupational participation as well. It was found that factors affecting occupational participation were mediated by personal values, and that the same factor may not affect occupational participation in the same way among different patients. In line with existing literature, the findings of the study supported occupational performance as the product of dynamic and interwoven relationships among person, occupation, and environment. In particular, the study outlined the characteristics of factors in social and cultural environments and their impact on occupational participation. Findings of the study may provide health professionals with useful information about the phenomena of occupational participation and advancing the care of this client population in the long-stay facility.第一章 緒論--------------------------------------1 第二章 文獻回顧----------------------------------4 第一節 名詞解釋----------------------------------4 第二節 參與職能活動與人類健康的關係--------------6 第三節 影響職能活動的因素：人—環境—職能模式----7 第三章 研究方法---------------------------------13 第一節 研究設計---------------------------------13 第二節 研究參與者-------------------------------13 第三節 研究工具與資料收集過程-------------------14 第四節 資料處理與分析---------------------------15 第四章 研究發現---------------------------------17 第一節 研究參與者的職能特質及職能參與情形---18 第二節 機構生活對健康及安適感的影響---------20 第三節 影響研究參與者職能參與的因素---------22 第五章 研究討論---------------------------------35 第一節 長期收容機構的社會文化環境特徵-------36 第二節 研究參與者的相對比較經驗-------------38 第三節 臨床應用-----------------------------41 第四節 研究限制-----------------------------45 第五節 未來研究建議-------------------------46 參考文獻-----------------------------------------47 附錄---------------------------------------------59 附錄一 慢性精神病患長期收容養護照顧統計---------59 附錄二 慢性精神病患之職能特質—初探性研究主要內容與結果--63 附錄三 機構同意書-------------------------------68 附錄四 行政院衛生署玉里醫院醫學教育委員會會議紀錄--------70 附錄五 行政院衛生署玉里醫院人體試驗委員會會議記錄--------72 附錄六 研究訪談同意書---------------------------75 附錄七 研究說明書及家屬同意書-------------------76 表目錄 表一 影響職能參與的相關因素---------------------54 表二 研究參與者的人口學資料統計-----------------55 表三 研究參與者的基本資料-----------------------56 表四 長期收容之慢性精神分裂症病患的職能特質及職能參與情形-57 表五 影響長期收容慢性精神分裂症病患職能參與的因素--------58738854 bytesapplication/pdfen-US機構化質性研究職能治療qualitative researchoccupational therapyinstitutionalizationtexthttp://ntur.lib.ntu.edu.tw/bitstream/246246/55404/1/ntu-93-R91429005-1.pdf