高依从性精神分裂症患者日间康复体验的质性研究

刘亚芳; 郗小玲; 徐昭君; 李现文

doi:10.16766/j.cnki.issn.1674-4152.002149

高依从性精神分裂症患者日间康复体验的质性研究

doi: 10.16766/j.cnki.issn.1674-4152.002149

1.
南京医科大学护理学院，江苏南京 211166
2.
南京市青龙山精神病院护理部，江苏南京 211123

基金项目:

江苏省高校哲学社会科学项目 2017SJB0285

江苏省高校品牌专业建设工程一期项目 PPZY2015C226

详细信息

通讯作者:
李现文，E-mail：xwli0201@njmu.edu.cn

中图分类号: R749.3 R493
计量
- 文章访问数: 250
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- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-08
- 网络出版日期: 2022-02-15

Qualitative study of daytime rehabilitation experience in patients with high-compliance schizophrenia

1.
School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China

摘要

摘要: 目的探讨高依从性精神分裂症患者参与日间康复的内心感受与体验，为开发针对患者需求的有效干预提供借鉴。方法采用目的抽样法选取2018年11月—2019年1月在南京市佑安家园日间康复中心14例高依从性精神分裂症患者进行半结构式访谈，运用质性研究中的现象学研究方法对资料进行整理分析。结果 14例受访者均能感知日间康复对自身疾病及生活的正性影响，综合受访者的康复体验，分析萃取出4个主题：康复效果的感知表现为日间康复对负性情绪的改善、复发及再住院频率减少；康复促进认知重建表现为肯定自我价值、重建生活乐趣；康复促进行为建立表现为提高生活能力、建立药物自我处置模式、积极应对复发先兆、主动利用医疗资源及社会支持；管理模式与现实问题的冲突表现为注重治疗与管理，忽略患者感受、保护性环境无法模拟现实社会。结论高依从性患者对日间康复效果及持续必要性认知充分。高依从性康复锻炼能有效促进病情的稳定，改变患者的认知，改善社会功能，提高生活质量。日间康复中心为患者提供多专业支持的社区康复服务，通过开设多元化的康复活动，满足患者需求，以提高康复依从性，是患者回归社会的有力保障。日间康复模式管理仍处于探索阶段，扩大精神卫生资源的利用需提高全社会的重视和参与。
- 精神分裂症 /
- 日间康复 /
- 康复体验 /
- 质性研究
Abstract: Objective To explore the inner feelings and experiences of patients with high-compliance schizophrenia participating in daytime rehabilitation, and to provide reference for the development of effective interventions tailored to the needs of patients. Methods The purposive sampling method was used to select semi-structured interviews of 14 patients with high-compliance schizophrenia from November 2018 to January 2019 in Nanjing Youan Homeland Day Rehabilitation Center. The phenomenological research method in qualitative research was used to sort out and analyze the data. Results All 14 respondents were able to perceive the positive impact of daytime rehabilitation on their own diseases and life. On the basis of their rehabilitation experience, four themes were extracted from the analysis: the perception of rehabilitation effect showed that daytime rehabilitation improved negative emotions, and the frequency of relapse and rehospitalization decreased. Rehabilitation promoted cognitive reconstruction by affirming self-worth and reconstructing life pleasure. The establishment of rehabilitation promotion behaviour included improving life ability, establishing drug self-management mode, actively coping with the recurrence aura and actively using medical resources and social support. The conflict between management mode and practical problems was that it pays attention to treatment and management and neglects the feelings of patients and protective environment, which could not simulate the real society. Conclusion Patients with high-compliance schizophrenia are fully aware of the effect of daytime rehabilitation and the necessity of continuous rehabilitation. High-compliance rehabilitation exercise can effectively promote the stability of the disease, change the patient's cognition of the disease, improve social function and improve the quality of life. The daytime rehabilitation centre provides community rehabilitation services with multidisciplinary support for patients. It can meet the needs of patients and improve rehabilitation compliance by setting up diversified rehabilitation activities, which is a powerful guarantee for patients to return to society. The management of daytime rehabilitation mode is still in the exploratory stage, and the whole society should pay more attention to and participate in expanding the utilisation of mental health resources.
- Schizophrenia /
- Day rehabilitation /
- Rehabilitation experience /
- Qualitative research

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参考文献(24)

[1]	FRANKISH H, BOYCE N, HORTON R. Mental health for all: A global goal[J]. Lancet, 2018, 392(10157): 1493-1494. doi: 10.1016/S0140-6736(18)32271-2
[2]	李飞, 黄晓琦, 吕粟. 积极开展精神分裂症的MR脑影像研究, 促进精神影像学的发展和临床应用[J]. 中华放射学杂志, 2018, 52(10): 729-730. doi: 10.3760/cma.j.issn.1005-1201.2018.10.001
[3]	田国强, 吴景竹, 吴明. 绍兴市社区精神分裂症患者复发的影响因素及其防治效果研究[J]. 浙江临床医学, 2018, 20(4): 727-729.
[4]	CHI M H, HSIAO C Y, CHEN K C. The readmission rate and medical cost of patients with schizophrenia after first hospitalization-A 10-year follow-up population-based study[J]. Schizophr Res, 2016, 170(1): 184-190. doi: 10.1016/j.schres.2015.11.025
[5]	王勋, 马宁, 王立英, 等. 2016年全国严重精神障碍患者管理治疗现状分析[J]. 中华精神科杂志, 2018, 51(1): 47-52. doi: 10.3760/cma.j.issn.1006-7884.2018.01.010
[6]	严芳, 姚丰菊, 李拴荣, 等. 同伴支持在社区精神分裂症患者中的应用[J]. 中华护理杂志, 2019, 54(10): 1545-1550. doi: 10.3761/j.issn.0254-1769.2019.10.020
[7]	蒋霞, 赵文莉, 潘卫民, 等. 甘肃省70 538例居家重性精神疾病患者管理效果评价[J]. 中国神经精神疾病杂志, 2017, 43(1): 26-30. doi: 10.3969/j.issn.1002-0152.2017.01.006
[8]	陈丽芬, 路孝琴. 社区精神分裂症家庭照顾者社会支持研究进展[J]. 中华全科医学, 2016, 14(6): 1022-1025. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201606047.htm
[9]	熊智, 余建英, 邓佳辉. 积极性社区康复及干预对精神分裂症患者精神症状及家庭经济负担的影响[J]. 海南医学, 2017, 28(02): 339-342. doi: 10.3969/j.issn.1003-6350.2017.02.059
[10]	赵俭, 李从红, 毕翠云. 精神分裂症患者在日间康复中心的体验研究[J]. 中华护理杂志, 2018, 53(11): 1298-1302. doi: 10.3761/j.issn.0254-1769.2018.11.003
[11]	吴明, 田国强, 吴景竹. 绍兴市社区精神分裂症患者治疗依从性影响因素的研究[J]. 浙江临床医学, 2018, 10(6): 1084-1087. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201810018.htm
[12]	BUOLI M, KAHN R S, SERATI M, et al. Haloperidol versus second-generation antipsychotics in the long-term treatment of schizophrenia[J]. Hum Psychopharm Clin, 2016, 31(4): 325. doi: 10.1002/hup.2542
[13]	李文玉, 涂文怡, 郑静, 等. 样本量对质性研究主题与现象诠释的影响研究[J]. 护理学报, 2020, 27(3): 62-65. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL202003018.htm
[14]	陈如梦, 王琰, 陈剑华, 等. ICD-11精神与行为障碍(草案)关于精神分裂症和其他原发性精神障碍诊断标准的进展[J]. 中华精神科杂志, 2017, 50(5): 345-347. doi: 10.3760/cma.j.issn.1006-7884.2017.05.006
[15]	刘慧明, 李国红, 赵列宾, 等. 电子监测与量表评估2型糖尿病患者服药依从性的研究[J]. 上海交通大学学报, 2016, 36(6): 901-905. doi: 10.3969/j.issn.1674-8115.2016.06.023
[16]	肖湘杰. 谈内容分析法在硕士学位论文中的应用[J]. 教育现代化. 2018, 3(13): 213-214. https://www.cnki.com.cn/Article/CJFDTOTAL-JYXD201813094.htm
[17]	陈丽芬, 路孝琴. 社区精神分裂症家庭照顾者社会支持研究进展[J]. 中华全科医学, 2016, 14(6): 1022-1025. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201606047.htm
[18]	陈春棉, 林崇光, 姜德国. 药物副反应主观体验对精神分裂症服药依从性的预测作用[J]. 中华全科医学, 2021, 19(2): 274-279. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202102031.htm
[19]	郎芳, 王唯平, 张增国, 等. 精神分裂症阴性症状的非药物治疗进展[J]. 广东医学, 2018, 39(增刊): 278-284. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX2018S2098.htm
[20]	沈玉蓉, 熊燕, 李广珍, 等. 会所模式日间康复在首发恢复期精神分裂症病人中的应用[J]. 护理研究, 2016, 30(4): 1453-1455. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201612015.htm
[21]	蔡清艳, 张岚, 王钰, 等. 精神分裂症患者再入院研究进展[J]. 临床精神医学杂志, 2019, 29(5): 353-355. doi: 10.3969/j.issn.1005-3220.2019.05.022
[22]	党云皓, 张辉, 苏艳丽, 等. 5次以上再入院精神分裂症患者临床特点分析[J]. 临床医学研究与实践, 2019, 22(5): 188-192. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201912075.htm
[23]	杨莉, 蔡军, 张伟波, 等. 精神分裂症患者康复需求的定性研究综述[J]. 精神医学杂, 2018, 31(2): 157-160. doi: 10.3969/j.issn.2095-9346.2018.02.022
[24]	河海珍, 凌秾喜. 精神分裂症患者复发与家庭支持相关性分析[J]. 吉林医学, 2019, 40(8): 1905-1908. doi: 10.3969/j.issn.1004-0412.2019.08.121