| 摘要註: |
本論文擬以某南部國軍醫院之慢性病房思覺失調症個案為研究對象。將依據DMAIC之問題解決與改善步驟來探討慢性思覺失調症個案接受復健治療前後之個人及社會功能與睡眠品質改善。DMAIC是一套問題解決與品質改善的系統性方法與步驟,其中D代表定義(Define)、M代表衡量(Measure)、A代表分析(Analyze)、I代表改善(Improve)、C代表控制(Control)。本論文首先經由精神科專業人員針對慢性病房思覺失調症個案,完成其個人及社會功能量表(Personal and Social Performance Scale, PSP),以了解病人精神症狀的嚴重度。其次針對個案之睡眠品質調查,擬採用匹茲堡睡眠品質評量表(Pittsburgh Sleep Quality Index, PSQI)來衡量與分析,由接受復健治療的病患自填的方式來進行。本論文於受試者納入研究後與第四、八週時進行上述兩項量表評估。最後經由DMAIC之問題解決與改善步驟,進一步提出慢性病房精神治療改善與解決方案,以提升慢性思覺失調症個案接受復健治療之個人及社會功能與睡眠品質。研究結果發現以下結論:一、本研究的個案的平均年齡為47.8±10.5歲,約54.4%為男性。二、研究結果顯示個人及社會功能量表(PSP)在接受治療後的第四週,各分項及總分皆達到統計上顯著;雖然第八週相對於第四週進行成對樣本t檢定在各分項及總分未達顯著標準,但仍表示持續接受藥物治療可以繼續維持病人之個人及社會功能之改善狀況。三、研究結果顯示PSQI量表之成對樣本t檢定在治療後除第四週睡眠總時數無顯著差異(t = -1.758, P >0.05);第八週相對於第四週病患的睡眠效率已達良好,故改善幅度未達顯著(t = 2.046, P >0.05)。其餘五個分項均呈現顯著差異,表示藥物治療可以有效幫助改善病人之睡眠品質。我們的研究結果發現在慢性病房大部份思覺失調症個人主觀睡眠品質有不佳情形,且常有白天活動功能障礙發生,應可適度的增加身體活動量(體適能活動、娛樂治療等),建議個案仍需要持續藥物治療和其它精神復健治療來維持個人與社會功能及睡眠品質改善。 This study is intended to be schizophrenia patients in chroinc ward of one southern military hospital. We had based on problem-solving and improvement steps to investigate personal and social function and improve quality of sleep in schizophrenia patients before and after rehabilitation treatment in according with DMAIC. DMAIC is a systematic approach to problem-solving steps and quality improvement, which D represents definitions (Define), M on behalf of measure (Measure), A representative of analysis (Analyze), I on behalf improve (Improve), C representing the control (Control). In this study, first psychiatric professionals completed their personal and social function scales (PSP) in order to identify the severity of psychiatric symptoms in patients. Secondly, we proposed patients in treatment self-administered approach to Pittsburgh sleep quality rating scale (PSQI) to measure and analyze the quality of sleep. In this paper, the subjects respectively accomplished above two assessment scales after they were included in the study and fourth, eight weeks later. Finally, according to problem-solving and improvement steps of DMAIC, we further proposed improvement and solutions of treatment process in chronic psychiatric ward to achieve personal and social function and sleep quality in schizophrenia after series of rehabilitation therapy. This study found that the following conclusions:1.The average age of cases in this study was 47.8 ± 10.5 years, about 54.4 percent were men. 2.The study show that personal and social function scale (PSP) is statistically significant in each items and total scores after treatment of four weeks. Although each items and total scores of paired sample t test aren't significant in the eighth week compared to the fourth week, but it still indicates the patients need taking medication in compliance to maintain the improvement of the individual and social function.3.The study show that paired t-test of PSQI scale after treatment isn't significant except the total sleep time of the fourth week (t = -1.758, P> 0.05). The sleep efficiency of the patients got well in the eighth week compared to the fourth week, so the margin of the improvement isn't significant. (t = 2.046, P> 0.05). Because all other five items are significant, it indicates that drug therapy can effectively help to improve the patient's quality of sleep.Our study found that sleep quality of most schizophrenia in chronic ward is poor, and often occurs in daytime dysfunction. We should increase gradually the amount of schizophrenia inpatient's physical activity (physical fitness activities, recreation therapy, etc.), and suggest that these patients still need continuous medication and other psychiatric rehabilitation therapy to maintain personal and social function and improve the quality of sleep. |