臺灣精神科慢性病房產業治療運作之探討：職能治療師觀點

前言：職能治療核心理念為利用參與活動促進個案功能發展、維持功能及減緩功能退化。過去產業治療之研究關注於治療療效，較少探討產業治療運作及發展之脈絡。本研究之目的在深入探討台灣精神慢性病房現有的產業治療運作脈絡及不同應對策略。研究方法：本研究中採用立意抽樣，訪談8所精神科職能治療單位之職能治療師。使用半結構深度訪談、參與觀察方式，並佐以相關文件表單收集資料。訪談全程之錄音檔轉譯成逐字稿做為分析之文本，所有資料以紮根理論分析方式進行分析。研究結果：經譯碼、分析後共得11個主要範疇，本研究之核心範疇為「職能重塑」，此核心範疇具有兩個重要性質「資源」與「職能治療師復元導向」而構成不同的脈絡，於不同脈絡底下，機構有著不同產業治療運作方式並展現特有的成果。結論：本研究發現有許多項目將影響慢性精神病房的產業治療運作，然而其中非外在環境的因素便是職能治療師本身。因此建議臨床工作人員適時展現創造力及主動性，提供個案較完善的治療計畫，並於職能治療師養成教育時應多注重這方面經驗。本研究成果有助於精神科產業治療研究者、臨床工作者及職能治療教育人員對於此議題更全面地了解。

Introduction: The core belief of occupational therapy is that engaging in activities can improve, maintain, or prevent the degeneration of clients’ function. Past studies on industrial therapy mostly focused on therapeutic effects and less on the contexts of the practice and development of industrial therapy. The purpose of this study was to explore the contexts and different strategies of the practice of industrial therapy in chronic psychiatric wards in Taiwan.Methods: A total of 8 occupational therapists in different occupational therapy settings were purposively sampled for this study. Data were collected from in-depth semi-structured interviews, participation observations, and related files/forms. The interviews were audiotaped and transcribed verbatim as texts for analysis. All the data were analyzed with grounded theory.Results: A total of 11 main categories were identified through coding and analysis. The core category was “Occupational Remodeling”. “Resources” and “Recovery-orientation of Occupational Therapist” were two properties of the core category and constructed various contexts. In different contexts, the facilities practiced Industrial Therapy differently and exhibited specific results.Conclusion: The study found that many items affect the practice of Industrial Therapy in chronic psychiatric wards, and the most non-circumstantial factor is the occupational therapists themselves. Therefore, we suggest that clinicians show more creativity and initiative to provide the clients high-quality therapeutic programs, and pay more attention to their experiences in this area during the occupational therapist development education. The results of this research may help researchers, clinicians in psychiatric industrial therapy, and educators in occupational therapy understand this subject thoroughly.