身心科病人受多重因素交互影響，造成跌倒發生率高。精神病用藥的神經副作用、精神疾病的症狀干擾或因年紀大侷限活動致肌力與平衡能力變差均會增加病人跌倒的風險。因本院身心科病人跌倒發生率逐年上升，病人步態不穩是跌倒的主因。於2016年對本院身心科病人施測，結果顯示病人下肢肌力及平衡能力不佳：下肢肌力30秒椅子起坐平均11.07下；單腿站立平衡平均左腿26.0秒、右腿25.54秒。分析可能原因有五：護理師或照服員欠缺肌力與平衡訓練之再教育、肌力訓練與防跌課程未列入新進人員教育訓練、病人缺乏獎勵致活動動機低落、單位缺乏身體運動模式設計、和未提供病人常態性運動時段。因此擬定改善措施，包括：舉辦教育訓練課程、新增和修訂新進人員手冊、拍攝多媒體影音教材、發展身體運動模式、規範身心科病人運動時段、及增加正向獎勵措施。執行專案改善措施後，2017年對病人再次施測，病人30秒椅子起坐增加至11.87下、單腿站立左腿增加至38.21秒和右腿增加至38.54秒，且本院身心科病人跌倒發生率因而獲得改善。期望本專案能提供身心科專業人員參考，以提升病人的下肢肌力及平衡能力、預防跌倒。

There is a high incidence of accidental falls due to multiple interactive factors among psychiatric patients. Neurological side-effects with psychiatric medications, symptoms of psychiatric diseases, ageing restrict physical activity, deterioration of muscle strength and balance function, all result in increased risk-of-falls. As the incidence of falls showed a year-on-year increase in our psychiatric ward, the main cause was discovered to be the patients’ instability of the gait. In 2016, patients’ average muscle strength of lower extremity was 11.07 by a 30-second sit-ups measure, while the average seconds of one-leg balance standing in left leg was 26 seconds and in right leg 25.54 seconds. Five causes resulted in this situation: lack of educational training courses in nurses/attendants, lack of training manuals for new staffs, lack of reinforcement for patients to participate in activities, lack of exercise model for patients, and lack of regular physical-activity for patients. Therefore, a project was implemented to enhance patients’ muscle strength and balance function, including conducting educational training courses for nurses/attendants, establishing and revising training manuals for new staffs, creating multimedia materials, developing exercise model based on muscle strength and balance training, arranging regular physical-activity for patients, and providing reinforcement when patients participating in activities. After the project, in 2017, patients’ average muscle strength of lower extremity was 11.87 by the 30-second sit-ups measure, while the average seconds of one-leg balance standing in left leg was 38.21seconds and in right leg 38.54 seconds. Consequently, it resulted in decreased incidence of falls. It is expected that this project could provide a reference to improve the muscle strength/balance of lower extremity and prevent falls for psychiatric patients.