Huang Xuan-Yi, Lin Mei-Jue, Yang Tuz-Ching, Sun Fan-Ko
School of Nursing and Nursing Department, China Medical University and Hospital, Taiwan.
J Clin Nurs. 2009 Nov;18(21):2956-68. doi: 10.1111/j.1365-2702.2009.02908.x. Epub 2009 Sep 3.
The purpose of this study is to generate a substantive theory of hospital-based home care for people with severe mental illness in Taiwan.
Despite the documented advantages of hospital-based home care services, there is a lack of information and understanding regarding the practices, functions and limitations. Currently, there is no model for how those services are to be provided and what factors will affect these services.
The grounded theory method of Strauss and Corbin (Basics of Qualitative Research: Grounded Theory Procedures and Techniques, SAGE Publications, 1990) was used to develop a substantive theory through a paradigm model, including causal conditions, context, intervening conditions, action/interaction strategies and consequences.
This study was conducted in six different hospital areas in Central Taiwan in 2007-2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed.
A substantive theory of hospital-based home care for people with severe mental illness in Taiwan was developed. The core category was the process of hospital-based home care in helping people with severe mental illness, with 15 categories and 33 sub-categories of the substantive theory.
The substantive theory is the first to emerge from hospital-based home care services in Taiwan. Results showed those services had several effective functions for helping people with severe mental illness and their families.
The recommendations based on the findings of this research can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling people with severe mental illness and their carers.
本研究旨在构建一个关于台湾地区为重度精神疾病患者提供的医院居家照护的实质性理论。
尽管已有文献记载医院居家照护服务的诸多优势，但对于其实践、功能及局限性，仍缺乏相关信息与了解。目前，尚无关于这些服务应如何提供以及哪些因素会影响这些服务的模式。
采用施特劳斯和科尔宾的扎根理论方法（《定性研究基础：扎根理论程序与技术》，SAGE出版社，1990年），通过一个范式模型来构建实质性理论，该模型包括因果条件、情境、干预条件、行动/互动策略及结果。
本研究于2007年至2008年在台湾中部的六个不同医院区域开展。通过半结构化面对面访谈收集数据。在开放编码、轴心编码和选择性编码过程中持续进行持续比较分析，直至数据饱和。采用理论抽样选取参与者。当达到理论饱和时，对21名精神疾病患者、19名照护者和25名专业人员进行了访谈。
构建了一个关于台湾地区为重度精神疾病患者提供医院居家照护的实质性理论。核心类别是医院居家照护帮助重度精神疾病患者的过程，该实质性理论包含15个类别和33个子类别。
该实质性理论是台湾地区医院居家照护服务中首次出现的理论。结果表明，这些服务在帮助重度精神疾病患者及其家庭方面具有多种有效功能。
基于本研究结果提出的建议可作为指南，用于改善为社区中重度精神疾病患者及其照护者提供医院居家照护服务的质量。
