[[alternative]]Effects of Smoking Cessation Intervention in Schizophrenia Patients

[[abstract]]目的:本研究目的為探討耳穴貼壓法結合戒菸衛教，對精神分裂症病人生理與心理之成效；並運用質性研究方法了解不同階段精神分裂症病人之戒菸經驗感受，以及復健機構中護理人員對該族群戒菸行為與無菸政策之看法。方法:採前、後測類實驗研究設計，研究對象為社區精神分裂症吸菸病人，依機構分為實驗組與對照組。實驗組以團體方式進行戒菸處置措施，每週1次，每次60分鐘，持續8週，並於第8週進行後測、第12週進行追蹤評估。結果:後測時實驗組之改變量與對照組之改變量，在尿中可體寧濃度、吐氣一氧化碳濃度、LF、FEV1、FEV%以及菸害認知達顯著差異。追蹤測時實驗組之改變量與對照組之改變量，在以下變項:尿中可體寧濃度、吐氣一氧化碳濃度、SDNN (standard deviation of the NN intervals)、TP(Total Power)、LF以及菸害認知，達顯著差異。兩組於介入後8週(後測)、以及介入後12週(追蹤測)，以尿中可體寧濃度100ng/ml為切點，戒菸率分別為:實驗組19.2%、13.5%；對照組2.0%、0%的戒菸率。在質性研究結果方面：依據研究設計所蒐集之資料，分析、整理個案對抽菸的想法感受，歸納主題為「擺盪」，並包含以下三個次主題，分別為「與香菸的結合-來自身、心、社會環境的影響」、「減菸的開始-感受到香菸對身體、形象以及金錢上的危害」與「減菸過程的轉變」。而康復之家護理人員對個案抽菸的想法感受，歸納主題為「為難」，並包含三個次主題，分別為「抽菸是不好的 vs. 抽菸對個案很重要」、「期待個案不抽菸 vs. 抽菸的個案不可能不抽菸」與「積極嘗試幫個案戒菸 vs. 選擇睜一隻眼閉一隻眼」。結論：實驗組研究對象在接受耳穴貼壓法結合戒菸衛教之措施後，吸菸行為相關之生物偵測指標、肺功能之改變量明顯優於對照組，而精神病理與心理層面指標並無惡化之情形。由本研究結果可知，精神病患者是能夠參與戒菸或減菸措施。精神科專業領域之醫護人員是第一線接觸的人員，因此，應積極培育精神專業醫護理人員具備戒菸之知識與諮詢能力，在鼓勵病人戒菸的同時，加入身心照護，藉由鼓勵精神分裂症病人逐步減少菸量為目標，達減害之治療目的，進而提升戒菸成功率。對於未來研究，建議延長措施介入之時程，並將戒菸的初期目標訂在減少抽菸數量上，採具彈性之護理照護取向。關鍵字: 精神分裂症病人，耳穴貼壓法結合戒菸衛教，可體寧，心率變異性，肺功能[[abstract]]Objective: This study aimed to examine the effects auricular acupressure combined with of smoking cessation education program on with schizophrenia patients in community. We also used qualitative research methods to understand the different stages of schizophrenia patients experience for smoking cessation, and rehabilitation agencies nursing staff views about smoking cessation behavior in this population and smoke-free policy. Methods: A pre-posttest quasi-experimental research design was used. 103 outpatients with schizophrenia was recruited from 16 rehabilitation agencies and divided into two groups of the experimental and the comparison. The program involved 60 min per time, and 1 time per week for 8 weeks. All participants provided written informed consent and were assessed before the intervention, post-test (8 weeks after initial assessment), and fellow-up test (12 weeks following initial assessment). Results: The post-test changes in the experimental group comparison with comparison group changes including the urinary cotinine concention, exhaled carbon monoxide concentration, LF, FEV1, FEV% and the knowledge of smoking were significant differences. The changes of fellow-up test in the experimental group compare with comparison group including the urinary cotinine concention, exhaled carbon monoxide concentration, SDNN (standard deviation of the NN intervals), TP (Total Power), LF and the knowledge of smoking are significant differences. The study used urinary concentration of 100ng/ml as the cutoff point. The 7-day point prevalence of abstinence rates at 8 weeks (post-test) , and 12 weeks (fellow-up test) of the study was 19.2%, 13.5% in experimental group and 2.0% versus 0% in comparison group, respectively. The results in qualitative research: based on research design collected data and analysis the experience of the smoking clients. Summed up the theme of "swing", and contains the following three sub-themes, namely “One person combined with cigarettes - influenced by physical, psychological, and social environment” “Star lessen cigarettes-perceptive the harm of cigarettes on physical, image and finical” and “the transform from reduction smoking.” The experience toward the smoking clients and free smoking policy of the rehabilitation nurses, summed up the theme of “Embarrassed”, and contains the following three sub-themes, namely “Looking forward to the clients do not smoke vs. Smokers impossible does not smoke” “Smoking is bad vs. Smoking is very important for client” and “Actively trying to help clients quit smoking vs. choose pretend not to notice.”Conclusion: The experimental group received auricular acupressure with structural group education of smoking cessation, the changes in smoking-related bio-physiological indicators, heart rate variability, and lung function was significantly better than the control group at post-test. It does not appear to have an adverse effect on psychological or psychopathology. From this study showed that the mentally ill are able to participate in smoking cessation or reduction. Professional staffs of psychiatry contact with schizophrenic smokers on the first line, therefore, should actively cultivate the mental health professional have the knowledge and consulting capacity to quit, and increasing the efficacy of these interventions may be achieved through extending the duration of intervention, providing them in the context of mental health care, promoting reduction as an acceptable initial treatment goal, and adopt a flexible approach.Key words: schizophrenia, auricular acupressure combined with of smoking cessationeducation, cotinine, heart rate variability, lung functio