Intervention effects of rehabilitation training of mode of human occupation on self-efficacy and stigma of schizophrenia patients

doi:10.3761/j.issn.0254-1769.2022.02.005

Abstract

Abstract:

Objective To explore the intervention effects of rehabilitation training of mode of human occupation （MOHO） on self-efficacy and stigma of convalescent schizophrenic patients. Methods 103 inpatients with schizophrenia were randomly divided into a research group（53 cases） and a control group（50 cases）. The study group received a rehabilitation training of MOHO on the basis of anti-psychotic treatment and routine nursing, 5 times a week for 8 weeks. The control group received a routine rehabilitation training on the basis of anti-psychotic treatment and routine nursing. Before and after the intervention,the general self-efficacy scale（GSES） and the stigma scale for patients with mental illness（SSMI-C） were used to evaluate the effect of the intervention. Results The results of intra group comparison showed that GSES was（15.46±2.74） before intervention and（17.92 ±2.42） after intervention. Before the intervention,the total score of stigma was（52.12±7.53）,discrimination was （21.36±6.83）,disease concealment was （17.28±4.45）,positive effect was（13.48±3.81）;after the intervention,the total score of stigma was （41.66±4.95）,discrimination was（16.84±4.02）,disease concealment was （14.18±2.75）,and positive effect was（10.64±2.38）. The difference was statistically significant（P<0.001）. The comparison results within the control group showed that the post test score of self-efficacy was higher than the pretest score,and there was no significant difference in GSES score,total score of stigma,discrimination,disease concealment and positive effect factor score（P>0.05）. After the intervention,the GSES score of the research group was higher than that of the control group,and the total score and each dimension score of stigma were lower than those of the control group（P<0.001）. Conclusion The rehabilitation training of MOHO can effectively reduce the level of stigma and improve the sense of self-efficacy.

Key words: Mode of Human Occupation, Schizophrenia, Self-Efficacy, Stigma, Rehabilitation Nursing, Psychiatric Nursing

摘要：

目的探讨人类职能模式康复训练对康复期精神分裂症患者自我效能及病耻感的干预效果。方法采用方便抽样法,选取2020年8月—2021年3月在江西省赣州市某三级甲等精神专科医院住院的103例康复期精神分裂症患者作为研究对象,随机分为试验组（53例）和对照组（50例）。两组均接受抗精神病药物治疗及常规护理,在此基础上,试验组进行人类职能模式康复训练,每周5次,共8周,对照组进行常规康复训练。两组干预前后采用一般自我效能感量表和精神疾病患者病耻感量表中文版评价干预效果。结果试验组一般自我效能感量表干预前得分为（15.46±2.74）分,干预后得分为（17.92±2.42）分,高于干预前;干预前精神疾病患者病耻感量表中文版总分为（52.12±7.53）分、歧视分量表得分为（21.36±6.83）分、病情掩饰分量表得分为（17.28±4.45）分、积极效应分量表得分为（13.48±3.81）分,干预后精神疾病患者病耻感量表中文版总分为（41.66±4.95）分、歧视分量表得分为（16.84±4.02）分、病情掩饰分量表得分为（14.18±2.75）分、积极效应分量表得分为（10.64±2.38）分,均低于干预前,差异均有统计学意义（P<0.001）。对照组一般自我效能感量表得分、病耻感总分、歧视分量表、病情掩饰分量表、积极效应分量表得分干预前后比较,差异均无统计学意义（P>0.05）。干预后试验组一般自我效能感量表得分高于对照组,精神疾病患者病耻感量表中文版总分及各维度得分低于对照组,差异有统计学意义（P<0.001）。结论人类职能模式的康复训练能够有效降低患者的病耻感水平,提高自我效能感。

关键词: 人类职能模式, 精神分裂症, 自我效能, 病耻感, 康复护理, 精神病护理学

YUAN Shuilian, WU Zhenhong, ZHANG Qian, LI Yang, LI Jiangchan, GUO Longrun, SU Jianning. Intervention effects of rehabilitation training of mode of human occupation on self-efficacy and stigma of schizophrenia patients[J]. Chinese Journal of Nursing, 2022, 57(2): 158-164.

袁水莲, 伍振红, 张倩, 李扬, 李江婵, 郭隆润, 苏建宁. 人类职能模式康复训练对精神分裂症患者自我效能及病耻感的干预效果[J]. 中华护理杂志, 2022, 57(2): 158-164.

Figures/Tables 4

Table 1 Content of rehabilitation training

Table 2 Comparison of general information between the two groups

Table 3 Comparison of GSES scores between the two groups before and after intervention（score,$\bar{x}\pm s$）

Table 4 Comparison of total SSMI-C scores and factor scores before and after intervention between the two groups（score,$\bar{x}\pm s$）

References 21

[1]	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.
	Zhao J, Li CH, Bi CY. The rehabilitation experiences of schizo-phrenia patients in day care centres[J]. Chin J Nurs, 2018, 53(11):1298-1302.
[2]	邓洁, 刘义婷, 李亚敏. 精神分裂症患者病耻感的研究进展[J]. 解放军护理杂志, 2020, 37(4):75-77.
	Deng J, Liu YT, Li YM. Research progress of stigma in pa-tients with schizophrenia[J]. Nurs J Chin PLA, 2020, 37(4):75-77.
[3]	Tania L, Sabina A, Iliana GO, et al. Canadian treatment guidelines on psychosocial treatment of schizophrenia in children and youth[J]. Can J Psychiatry, 2017, 62(9):648-655. DOI URL
[4]	谭晓林, 文丽, 杨冰香, 等. 团体自我肯定训练对精神分裂症患者病耻感的干预效果研究[J]. 中华护理杂志, 2018, 53(10):1168-1173.
	Tan XL, Wen L, Yang BX. Effects of a group self-assertiveness training intervention on stigma of patients with schizophrenia[J]. Chin J Nurs, 2018, 53(10):1168-1173.
[5]	Taylor RR. Gary Kielhofner’s model occupation:are-discovery of will[J]. Isra J Occupa Thera, 2011, 20(3):63-64.
[6]	Patricia B, Lauro M, Gorter C, et al. Occupational therapy,cancer,and occupation-centred practice:impact of training in the model of human occupation[J]. Aust Occup Ther J, 2020, 67(6):605-614. DOI URL
[7]	Ye-Ji J, Hee K. Effects of the model of human occupation-based home modifications on the time use,occupational participation and activity limitation in people with disabilities:a pilot randomized controlled trial[J]. Disabil Rehabil Assist Technol, 2020:1-7.
[8]	Moslem D, Mitra K, Malahat A, et al. Exploring the contributing factors that influence the volition of adolescents with cerebral palsy:a directed content analysis[J]. Scand J Occup Ther, 2020:1-11.
[9]	张国富, 李达, 查智群, 等. 基于人类职能理论指导下的训练方式对精神分裂症患者康复疗效的影响[J]. 实用医学杂志, 2013, 29(19):3160-3162.
	Zhang GF, Li D, Zha ZQ, et al. The rehabilitation effect of training pattern guided by Mode of Human Occupation in schizophrenia patients[J]. Prac Med, 2013, 29(19):3160-3162.
[10]	吴晓静. 基于人类作业模式的康复训练对抑郁症患者康复疗效的影响研究[D]. 青岛:青岛大学, 2018:1-66.
	Wu XJ. Research on the effect of rehabilitation training based on human working mode on the rehabilitation efficacy of patients with depression[D]. Qingda:Qingdao University, 2018:1-66.
[11]	刘士荣. 基于人类作业模式的康复训练对抑郁症患者抑郁程度、日常生活能力及社交技能的影响[J]. 护理实践与研究, 2020, 17(12):146-148.
	Liu SR. Effects of applying model of human occupational- based rehabilitation training for depression,ability of daily living and social skills of patients with depression[J]. Nurs Pract Res, 2020, 17(12):146-148.
[12]	范肖冬. ICD-10精神与行为障碍分类[M]. 北京: 人民卫生出版社, 1993.
	Fan XD. ICD-10 classification of mental and behavioral disorders[M]. Beijing: People’s Medical Publishing House, 1993.
[13]	王才康, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究[J]. 应用心理学, 2001, 7(1):37-40.
	Wang CK, Hu ZF, Liu Y. Research on reliability and validity of General Self-Efficacy Scale[J]. Appl Psychol, 2001, 7(1):37-40.
[14]	陈璐, 王芳, 狄恒丹, 等. 颅内肿瘤患者围手术期疼痛管理方案的构建及应用研究[J]. 中华护理杂志, 2021, 56(6):824-830.
	Chen L, Wang F, Di HD, et al. Construction of evidence-based pain management program for patients with intracranial tumor during perioperative period and application effect research[J]. Chin J Nurs, 2021, 56(6):824-830.
[15]	耿峰, 董毅, Michael King, 等. 精神疾病病耻感量表中文版在精神分裂症患者中应用的信效度[J]. 中国心理卫生杂志, 2010, 24(5):343-346.
	Geng F, Dong Y, King M, et al. Reliability and validity of the Chinese-version of Stigma Scale for Mental Illness[J]. Chin Ment Heal J, 2010, 24(5):343-346.
[16]	冯辉, 陈玉明, 刘寒, 等. 积极心理团体训练对特殊教育教师心理弹性与自我效能的影响[J]. 中国心理卫生杂志, 2020, 34(8):7-14.
	Feng H, Chen YM, Liu H, et al. Effects of positive psychological group training on psychological resilience and self-efficacy in special education teachers[J]. Chin Ment Health J, 2020, 34(8):7-14.
[17]	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.
	Yan F, Yao FJ, Li SR, et al. Application of peer support in community mental health services to patients with schizophrenia[J]. Chin J Nurs, 2019, 54(10):1545-1550.
[18]	林国荣, 梁迎洁. 病人主导的生活技能自我管理小组训练对住院精神分裂症病人的影响[J]. 护理研究, 2020, 34(20):3601-3605.
	Lin GR, Liang YJ. Impact of patient led self-management group training of life skills on inpatients with schizophrenia[J]. Chin Nurs Res, 2020, 34(20):3601-3605.
[19]	Li J, Guo YB, Huang YG, et al. Stigma and discrimination experienced by people with schizophrenia living in the community in Guangzhou,China[J]. Psychiatry Res, 2017, 255:225-231. DOI URL
[20]	陆红英, 袁勤, 陶丽, 等. 支持性心理干预对社区精神分裂症病人病耻感的影响[J]. 护理研究, 2017, 3l(15):1831-1834.
	Lu HY, Yuan Q, Tao L. Influence of supportive psychological intervention on community schizophrenia patients with stigma[J]. Chin Nurs Res, 2017, 3l(15):1831-1834.
[21]	汪健健, 赵丽萍, 盛丽娟, 等. 精神分裂症患者内化耻感在自知力和自尊间的中介作用[J]. 中华行为医学与脑科学杂志2019, 28(9):817-820.
	Wang JJ, Zhao LP, Sheng LJ. The mediating role of internalized stigma between insight and self-esteem among patients with schizophrenia[J]. Chin J Behav Med & Brain Sci, 2019, 28(9):817-820.