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Part V ÀÒ¤¼¹Ç¡
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1. Angry
2. Distruct
3. Denial
4. Boundary
5. Seduction
6. Competitive
7. Aggressive
8. Sad & Fear
9. Poor compliance
10.Medicine Shopping
11. Cultural Difference
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• ¼ÙŒ»†Ç ¤ÃѺ (ÂÔéÁ ·‹Ò·Ò§ÁÕ¤ÇÒÁÊØ¢·Õè¹Ö¡¶Ö§ÅÙ¡) à¢Ò¾Ù´ä´Œ»ÃÐâ¤ÊÑé¹ æ áŌǤÃѺ

• ᾷ â͌âË âµàÃçÇàÊÕ´ŒÇ ¤§¡íÒÅѧ¹‹ÒÃÑ¡àªÕÂÇ ¤Ø³ÍÒÂØÂѧ¹ŒÍ âÍ¡ÒÊ·Õè¨Ð

໚¹ÁÐàÃ秹ŒÍ¤‹Ð ·Ò¹ÂÒáŌǷíÒã¨ãˌʺÒ´ÕÁÑé¤Р¾º¡Ñ¹ÍÕ¡ã¹ 2 ÊÑ»´Òˏ¹Ð¤Ð ÂÒ
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·ÕèËÁÍãˌÁÕ....µÑÇ à»š¹ÂÒ..... ¡Ô¹áŌÇÍÒ¨·íÒãˌÁÕÍÒ¡ÒÃ.... ¤Ø³µŒÍ§¡ÒÃÂÒª‹ÇÂãˌËÅѺ´ŒÇÂ

ËÃ×Íà»Å‹Ò¤Ð

• ¼ÙŒ»†Ç äÁ‹µŒÍ§¤ÃѺ Ãٌ¡çʺÒÂã¨áŌǤÃѺ ¤Ô´àͧ¤¹à´ÕÂÇÍÂÙµ‹ Ñ駹ҹ (ÂÔéÁáŒÁʺÒÂã¨)

• ᾷ ¶ŒÒÁÕÍÒ¡ÒÃÍÐäÃäÁ‹´Õ ÁÒ¡‹Í¹¹Ñ´ä´Œ¹Ð¤Ð ÁÕÍÐäÃÍÂÒ¡¶ÒÁËÁÍÍÕ¡ËÃ×Íà»Å‹Ò¤Ð

• ¼ÙŒ»†Ç äÁ‹ÁÕáŌǤÃѺ ¢Íº¤Ø³ËÁÍÁÒ¡¤ÃѺ ÊÇÑÊ´Õ¤ÃѺ

ÇÔà¤ÃÒÐˏ

• ¡ÒÃ㪌ÍÇѨ¹ÀÒÉÒ àª‹¹ ¡ÒÃáÊ´§ÍÍ¡ÊÕ˹ŒÒ ÊÒµҷÕèͺÍ؋¹ ·‹Ò·Ò§·ÕèáÊ´§ÍÍ¡¶Ö§

¤ÇÒÁ¼‹Í¹¤ÅÒ ¡ÒþÂѡ˹ŒÒáÊ´§ÍÍ¡¶Ö§¤ÇÒÁàËç¹´ŒÇ ¹éíÒàÊÕ§·Õè´Õ áÅСÒÃ㪌àÇÅÒ·Õè
µÃ§àÇÅÒ

• ·Ñ¡ÉСÒÿ˜§ µŒÍ§µÑé§ã¨¿˜§áÅÐ㪌¹éíÒàÊÕ§à¾×èÍ¡Ãе،¹ãˌ¼ÙŒ»†ÇÂáÊ´§ÍÍ¡¶Ö§¤ÇÒÁÃٌÊÖ¡
¹Í¡¨Ò¡¹Õéã¹°Ò¹ÐᾷµŒÍ§¾ÂÒÂÒÁµÕ¤ÇÒÁ¨Ò¡íÒ¾Ù´áÅСÒÃáÊ´§ÍÍ¡·Ò§ÍÇѨ¹ÀÒÉÒ
¢Í§¼ÙŒ»†Ç¾ÌÍÁ·Ñé§Ê×èÍÊÒôŒÇ¤íÒ¾Ù´·Õèµ¹àͧࢌÒã¨ãˌ¼ÙŒ»†Ç¿˜§

• ·Ñ¡ÉСÒöÒÁ ¾ÂÒÂÒÁ¶ÒÁ¤íÒ¶ÒÁ»ÅÒÂແ´ äÁ‹ªÕé¹íҼٌ»†Ç áÅоÂÒÂÒÁ¶ÒÁ¡Ãе،¹

ãˌ¼ÙŒ»†ÇÂàŋÒàÃ×èͧãˌ¿˜§

• ·Ñ¡ÉСÒÃãˌ¢ŒÍÁÙÅáÅФíÒ͸ԺÒ ¡ÒÃãˌ¢ŒÍÁÙżٌ»†Ç¹Ñé¹ÍÒ¨¨ÐÁÕ¡ÒÃãˌ¢ŒÍÁÙÅËÃ×ÍÊÑè§ãˌ
»¯ÔºÑµÔ´ŒÇ 㹡ÒÃãˌ¢ŒÍÁÙŹÑ鹤ÇÃÁÕ¡ÒÃáÊ´§¶Ö§¤ÇÁࢌÒ㨼ٌ»†ÇÂáÅÐãˌà˵ؼŻÃСͺ
ÍҨ㪌ἹÀÒ¾ËÃ×ÍÍØ»¡Ã³Í×è¹æà¾×èÍÊÒ¸Ôµãˌ´Ù㹡ÒÃ͸ԺÒÂ
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• ¡ÒÃÂÍÁÃѺ㹵ÑǼٌ»†ÇÂ(acceptance) ¤ÇÃÂÍÁÃѺ㹤ÇÒÁ໚¹ºØ¤¤Å ແ´ã¨·Õè¨ÐࢌÒã¨

¼ÙŒ»†Ç äÁ‹µÑ´ÊÔ¹ã¨àÃçÇà¡Ô¹ä»Ç‹Ò´ÕËÃ×ÍäÁ‹´Õ »Å.¡ÒÃáÊ´§ÍÍ¡·Ò§ÊÕ˹ŒÒ¢Í§ÍÒ¨º‹§ºÍ¡ä´Œ
Ç‹Ò á¾·ÂµÑ´ÊÔ¹¡ÒáÃзíҢͧ¼ÙŒ»†Ç¹Ñé¹´ÕËÃ×ÍäÁ‹´Õ ઋ¹ ¼ÙŒ»†ÇÂäÁ‹µÒÁ¹Ñ´ ᾷáÊ´§
¹éíÒàÊÕ§ËÃ×ÍÊÕ˹ŒÒ·ÕèäÁ‹¾Íã¨áµ‹¾Ù´¨Ò»¡µÔ ¼ÙŒ»†Ç¡çÊÒÁÒöÊѧࡵ䴌¨Ò¡ÊÕ˹ŒÒËÃ×Í
¹éíÒàÊÕ§䴌

• ¡ÒÃࢌÒã¨ã¹¤ÇÒÁÃٌÊÖ¡¢Í§¼ÙŒÍ×è¹(empathy) ࢌÒ㨤ÇÒÁÃٌÊÖ¡¢Í§¼ÙŒ»†ÇÂáÅÐáÊ´§¤ÇÒÁÃٌÊÖ¡
¹Ñé¹ÍÍ¡ÁÒ »Å. äÁ‹ãª‹ÁÕ¤ÇÒÁÃٌÊ֡໚¹Íѹ˹Öè§Íѹà´ÕÂǡѺ¼ÙŒ»†Ç ÊÒÁÒöᡵ¹àͧ
ÍÍ¡ÁÒ䴌 ¤ÇÒÁ¤Ô´Í¤µÔ ÅíÒàÍÕ§ ໚¹ÍØ»ÊÃäÊíҤѭ

• ¡ÒÃà¤Òþ㹤ÇÒÁ໚¹ºØ¤¤Å¢Í§¼ÙŒÍ×è¹ (respect) Áͧ˹ŒÒʺµÒ á¹Ð¹íÒµÑÇàͧ

àÃÕ¡ª×èͼٌ»†Ç´ŒÇ¤ÇÒÁÊØÀÒ¾ ÊÕ˹ŒÒáÊ´§¤ÇÒÁàÍÒã¨ãʋ ¶ÒÁ¤ÇÒÁµŒÍ§¡Òâͧ¼ÙŒ»†ÇÂ
äÁ‹¹íÒ¤ÇÒÁÅѺä»à»´à¼ÂËÃ×ÍÇԾҡɏÇÔ¨Òó

• ¤ÇÒÁàª×èͶ×ÍänjÇҧ㨠(trust) ¡ÒÃäÁ‹¼Ô´¹Ñ´ äÁ‹¼Ô´ÊÑ­­Ò¡Ñº¼ÙŒ»†Ç àŋҶ֧¤ÇÒÁ໚¹¨ÃÔ§

äÁ‹áÊ´§·‹Ò·Õ¡ÅѺä»ÁÒ »¯ÔºÑµÔ´ŒÇ¤ÇÒÁ«×èÍÊѵ ¤ÇÒÁÊÒÁÒö·Ò§ÇÔªÒªÕ¾ ÁÕ¤ÇÒÁ
ÊÁèíÒàÊÁÍáÅÐÁÕ¤íÒÁÑè¹ÊÑ­­Ò  ¼ÙŒ»†Ç¡ç¨Ðänjã¨á¾·Â

• ¡ÒÃÁÕʋǹËÇÁ¢Í§¼ÙŒ»†Ç ËÇÁáÊ´§¤ÇÒÁ¤ÇÒÁ¤Ô´àËç¹ Í¸ÔºÒÂà˵ؼÅàÁ×èͼٌ»†Ç¶ÒÁËÃ×Í

¡ÒõÃǨËҧ¡Ò·Õè¼ÙŒ»†ÇÂÍÒ¨äÁ‹à¢ŒÒã¨

สําคัญมากๆๆๆๆๆ  ¡ÒÃÊÌҧ¤ÇÒÁÊÑÁ¾Ñ¹¸à»š¹ËÑÇ㨢ͧ¡ÒûÃÐʺ¤ÇÒÁÊíÒàÃç¨ã¹¡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ
áÅСÒôÙáżٌ»†Ç ¤ÇÒÁÊÑÁ¾Ñ¹¸¹ÕéºÒ§¤ÃÑé§ãªŒà»š¹Ë¹Öè§ã¹¡ÒÃÃÑ¡ÉÒ ปญหาในการสื่อสาร 
ᾷ¢Ò´¤ÇÒÁˋǧãÂáÅФÇÒÁÁÕàÁµµÒ äÁ‹à¢ŒÒ㨤ÇÒÁÃٌÊÖ¡ ᾷäÁ‹ÁÕ·Ñ¡ÉСÒÃáÊ´§¶Ö§¤ÇÒÁࢌÒã¨
¤ÇÒÁÃٌÊÖ¡¢Í§¼ÙŒ»†ÇÂ
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Consultation and Calgary-Cambridge model

• Consultation (¡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ) ¤×Í ¡Ãкǹ¡Ò÷Õè¼ÙŒÃѺºÃÔ¡ÒâͻÃÖ¡ÉÒ¤íÒá¹Ð¹íÒ¨Ò¡¼ÙŒ

ãˌºÃÔ¡Òà â´Â·Ñ駼ٌÃѺºÃÔ¡ÒÃáÅмٌãˌºÃÔ¡ÒÃËÇÁ¡Ñ¹¾Ô¨ÒóҡíÒ˹´á¹Ç·Ò§ ¡ÒôíÒà¹Ô¹¡ÒÃÃÑ¡ÉÒ
âäáÅСÒû¯ÔºÑµÔµÑÇ
Understanding the consultation: Tasks

• à¾×èÍࢌÒã¨à˵ؼŢͧ¡ÒÃÁÒµÃǨÃÑ¡ÉÒ·Ñé§á§‹»˜­ËҢͧ¼ÙŒ»†ÇÂáÅÐÁØÁÁͧã¹ËÅÒÂ洌ҹ (To
understand the reasons for the patient’s attendance: problems, perspective)

• ¹íÒÁØÁÁͧ¢Í§¼ÙŒ»†ÇÂà¾×èÍãˌà¡Ô´¤ÇÒÁࢌÒã¨Ã‹ÇÁ¡Ñ¹·Ñ駻˜­ËÒ áÅзҧàÅ×͡㹡ÒÃÃÑ¡ÉÒ (Taking

into account the patient’s perspective, to achieve a shared understanding)

• ʹѺʹعãˌ¼ÙŒ»†ÇÂàÅ×Í¡¡ÒáÃзíÒ·ÕèàËÁÒÐÊÁã¹áµ‹Å똭ËÒ (To enable the patient to

choose an appropriate action for each problem)

• à¾×èͪ‹ÇÂãˌ¼ÙŒ»†ÇÂÊÒÁÒö¨Ñ´¡ÒáѺ»˜­ËÒ䴌 (To enable the patient to manage the

problem)

• à¾×èÍ»ÃÐàÁÔ¹»˜­ËÒÍ×è¹ æ (To consider other problems)

• à¾×èÍãˌ㪌àÇÅÒÍ‹ҧàËÁÒÐÊÁ·Ñé§ã¹¢ºÇ¹¡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ¤ÃÑ駹Ñé¹áÅÐã¹ÃÐÂÐÂÒÇ (To use time

appropriately)

• à¾×èÍÊÌҧËÃ×ͤ§¤ÇÒÁÊÑÁ¾Ñ¹¸¡Ñº¼ÙŒ»†Ç à¾×èͪ‹ÇÂãˌ»˜­ËÒÍ×è¹æ 䴌ÃѺ¡ÒÃᡌä¢Ã‹ÇÁ´ŒÇÂ

(To
establish or maintain a relationship with the patient that helps to achieve the
other tasks)
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 12

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• The Calgary-Cambridge model

• Initiating the Session

 establishing initial rapport

 identifying the reason(s) for the consultation

• Gathering Information

 exploration of problems

 understanding the patient's perspective

 providing structure to the consultation

• Building the relationship

 developing rapport

 involving the patient

• Explanation and planning

 providing the correct amount and type of information

 aiding accurate recall and understanding

 achieving a shared understanding: incorporating the patient's perspective

 planning: shared decision making

·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 13

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Content of consultation (Stott & Davies 1979)

• ¨Ñ´¡ÒáѺ»˜­ËÒ·Õè¹íÒÁÒ¾ºá¾·Â(Management of presenting problems)

• ¡ÒôÙáÅ»˜­ËÒ·Ò§´ŒÒ¹¨ÔµÊѧ¤Á

• ¨Ñ´¡Òû˜­ËÒàÃ×éÍÃѧ (Management of continuing problems )

• ¡ÒÃʋ§àÊÃÔÁÊØ¢ÀÒ¾áÅл‡Í§¡Ñ¹âä (Opportunistic health promotion)

The context of the consultation

• ¤ÇÒÁàª×èÍà¡ÕèÂǡѺÊÒà˵آͧâä (Beliefs about the causes of disease)

• ÁØÁÁͧ¢Í§Êѧ¤Áµ‹Í¸ÃÃÁªÒµÔ¢Í§¡ÒÃà¨çº»†Ç ( Society’s views on the nature of

illness)

• ÊØ¢ÀÒ¾áÅСÒúÃÔ¡ÒÃÊØ¢ÀÒ¾ (Health and health care)

• â¤Ã§ÊÌҧ¢Í§ÃкººÃÔ¡ÒÃÊØ¢ÀÒ¾ (The structure of health care systems)

• ¡ÒäǺ¤ØÁ·Ò§ÇÔªÒªÕ¾ (Professional regulation)

• ¡Ãͺ·Ò§¨ÃÔ¸ÃÃÁ (The ethical framework)

• ¡Ãͺ¢Í§¡®ËÁÒ (The legal framework)

·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 14

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º··Õè 3 : ËÅÑ¡¨ÔµÇÔ·ÂÒ¡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ

“㹡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ¹Ñé¹ÁÕËÅÑ¡¨ÔµÇÔ·ÂÒáÅзÄÉ®Õã´ºŒÒ§ã¹¡ÒÃãˌ¤íÒ»ÃÖ¡ÉҔ

Çѵ¶Ø»ÃÐʧ¤¢Í§á¾·Â¼ÙŒãˌ¡ÒûÃÖ¡ÉÒ

 ª‹ÇÂãˌ¤¹ä¢Œà¢ŒÒã¨ÍÒ¡ÒÃ

 ª‹ÇÂãˌࢌÒ㨻ÃÐʺ¡Òó·Ò§ÍÒÃÁ³áÅзҧÊѧ¤Á·ÕèÊÑÁ¾Ñ¹¸¡Ñº»˜­ËÒ

 ª‹ÇÂãˌ¤Ãͺ¤ÃÑÇ·Õè»ÃÐʺÀÒÇÐÇԡĵÔËÃ×ͤÇÒÁÂÒ¡ÅíҺҡ༪ԭ»˜­ËÒ

 ª‹Ç¤Œ¹ËÒÈÑ¡ÂÀÒ¾

 ãˌ¤íÒá¹Ð¹íҼٌµÔ´àª×éÍ HIV&AIDS

 䴌ÃѺ¤ÇÒÁänjÇÒ§ã¨ãˌ໚¹¼ÙŒ´ÙáÅÊØ¢ÀÒ¾
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·Äɮշҧ¨ÔµÇÔ·ÂÒ “¡ÒÃãˌ¤íÒ»ÃÖ¡ÉҔ

 The Psychodynamic Approach  ãˌ·íÒ¤ÇÒÁࢌÒã¨ÃÐËNjҧÊÔ觷Õ輋ҹÁҡѺ»˜¨¨ØºÑ¹

 ãˌࢌÒ㨡Ò÷íÒ§Ò¹¢Í§ÃдѺ¨ÔµãµŒÊíÒ¹Ö¡
(unconscious) ¼ÅÑ¡´Ñ¹¾ÄµÔ¡ÃÃÁ
¡Ãе،¹ãˌáÊ´§ÍÒÃÁ³
 The Behavioral Approach  ãˌࢌÒ㨻˜­ËҾĵԡÃÃÁ
 ãˌÊÒÁÒö»ÃѺ¾ÄµÔ¡ÃÃÁ·Õè໚¹»˜­ËÒªÕÇԵ䴌
ઋ¹ âäàºÒËÇÒ¹ âä͌ǹ »˜­ËҾĵԡÃÃÁà´ç¡

 The Humanistic Approach  ËÅÕ¡àÅÕ觡ÒÃá»Å¤ÇÒÁËÁÒ¢ͧ¾ÄµÔ¡ÃÃÁ

 ¾ÂÒÂÒÁª‹ÇÂãˌ¤¹ä¢Œä´Œ¤Œ¹ËÒáÅзíÒ¤ÇÒÁࢌÒã¨
¡Ñº»˜­ËÒ
 ÁÕ¤ÇÒÁµÃÐ˹ѡ·Õè¨ÐÃѺ¼Ô´ªÍºã¹¾ÄµÔ¡ÃÃÁ
µ¹àͧ

 The Cognitive Approach  ·íÒãˌ¼ÙŒ»†ÇÂÃٌÊ֡ͺÍ؋¹ÁÒ¡¡Ç‹Ò ¡ÒôØËÃ×͵íÒ˹Ô

 ·íÒãˌࢌÒ㨤ÇÒÁÊÑÁ¾Ñ¹¸¢Í§»˜­ËÒãˌµÃ§µÒÁ
¤ÇÒÁ໚¹¨ÃÔ§ ઋ¹ ¡Òö١¢‹Á¢×¹ ãˌàËç¹Ç‹Ò
ÍÇÑÂÇзءʋǹÁÕ¤ÇÒÁÊíҤѭ෋ҡѹ
¡Ãе،¹ãˌà¡Ô´¡ÒþѲ¹Ò
 The Gestalt-Therapy Approach  ¼ÙŒÃÑ¡ÉÒࢌÒã¨ã¹àÍ¡ÅѡɳÊ‹Ç¹ºØ¤¤Å
 ª‹ÇÂãˌ¼ÙŒ»†ÇÂÍÂً¡Ñº hear and now
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ËÅÑ¡¡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ

 Supportive counselling ãˌ¡íÒÅѧ㨠ʋ§àÊÃÔÁãˌÁÕ¤ÇÒÁ¤Ô´·Õè´Õ

ÃѺ¿˜§Í‹ҧµÑé§ã¨
ࢌÒ㨼ٌ»†Ç empathy
ª‹ÇÂãˌᡌ»˜­ËÒ䴌

 Informative counselling ãˌ¤ÇÒÁÃٌËÃ×Í¢ŒÍÁÙÅã¹ÃдѺ·Õè¡Ãзº¤ÇÒÁÃٌÊÖ¡

(feel)ËÃ×Í˹ŒÒ·Õè (function) ઋ¹ âä
HIV&AIDS
* Counsellor µŒÍ§¾Ñ²¹Òµ¹àͧãˌäǵ‹Í¤ÇÒÁÃٌÊÖ¡
㹡ÒÃÃѺÃٌ»˜­ËÒªÕÇÔµ¢Í§ clients

 Educational counselling ãˌ¡ÒÃÈÖ¡ÉÒãˌà¾×èÍãˌ»ÃѺà»ÅÕè¹Í‹ҧ

ÃÇ´àÃçÇ
Counsellor = tutor /
teacher/coaching +
therapist
·íÒ໚¹¡Å؋Á䴌

 Management counselling ¡ÒèѴ¡ÒáѺÃкºÊØ¢ÀÒ¾ÁÕ¡ÒÃà»ÅÕè¹á»Å§Í‹ҧ

ÃÇ´àÃçÇÀÒÂã¹àÇÅÒ 2 - 3 »‚
* ÁÑ¡ÁÕÇѲ¹¸ÃÃÁࢌÒÁÒà¡ÕèÂÇ¢ŒÍ§ ઋ¹ ¡ÒáԹ»ÅÒ
´Ôº
* ·íÒ䴌µÑé§áµ‹ÃдѺºØ¤¤Å件֧ÃдѺªÒµÔ
ÇÔ¸Õ¡ÒÃ
* ãˌ¡Òû¯ÔºÑµÔáÅЫÖÁ«Ñº ઋ¹ ´×èÁ¹éíÒÊÁعä¾Ã
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Counselling in crisis ÁÕÊÔ觷ÕèäÁ‹¤Ò´½˜¹à¡Ô´¢Í§ÁÒ㹪ÕÇÔµ ઋ¹ ¶Ù¡ rape ,

counsellor µŒÍ§µÑ´ÊÔ¹ã¨Í‹ҧÃÇ´àÃçÇ à¾×èÍ panic , sudden death , stress
¤Çº¤ØÁʶҹ¡Òó
* ª‹Ç¢¨Ñ´ÍÒÃÁ³·ÕèäÁ‹àËÁÒÐÊÁ ઋ¹ µ×蹡ÅÑÇ
àÈÃŒÒ µÖ§à¤ÃÕ´
* ãˌ¡Òà support
* ãˌàºÍÏ©Ø¡à©Ô¹ / hotline
 Post-trauma counselling 䴌ÃѺ¤ÇÒÁºÕº¤Ñ鹨ҡʶҹ¡ÒóãË­‹æઋ¹Ê§¤ÃÒÁ
ÇÔ¸Õ¡ÒÃ
1. ª‹ÇÂãˌÂÍÁÃѺ¤ÇÒÁ¨ÃÔ§
2. ¡Ãе،¹¤ÇÒÁÃٌÊÖ¡à¨çº»Ç´áÅÐãˌàÃÕ¹ÃٌÇÔ¸Õ¡ÒÃ
¨Ñ´¡ÒÃ
à¾×èÍ¡ÅѺࢌÒÊًÀÒÇл¡µÔ
3. ª‹ÇÂãˌ»ÃѺµÑÇËÃ×Í»ÃѺà»ÅÕè¹ÇÔ¶ÕªÕÇÔµ
4. ª‹ÇÂä»·ÕèÍÒÃÁ³áÅÐãˌÂÍÁÃѺ¡ÒÃÃÑ¡ÉÒ

 Counselling in spiritual distress ໚¹¡ÒÃà»ÅÕè¹á»Å§ã¹ÃдѺ¨ÔµÇÔ­­Ò³

㪌㹡Å؋ÁÇÔªÒªÕ¾·Ò§¨ÔµàǪ
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Åѡɳмٌãˌ¡ÒûÃÖ¡ÉÒ

 ÁÕÊØ¢ÀÒ¾¨Ôµ´Õ ¤×ÍÁÕ¡ÒõÃÐ˹ѡÃٌáÅÐࢌÒ㨵¹àͧÍÂًàÊÁÍ ÊÒÁÒöÁͧÊÔ觵‹Ò§æ䴌µÃ§µÒÁ¤ÇÒÁ໚¹

¨ÃÔ§ ÃÐÁÑ´ÃÐÇѧ ·Ñȹ¤µÔ ÍÒÃÁ³áÅФÇÒÁÃٌÊÖ¡

 Ãٌ¨Ñ¡ÊÌҧÊÑÁ¾Ñ¹¸ÀÒ¾ ໚¹¼ÙŒ¿˜§·Õè´Õ¿˜§Í‹ҧµÑé§ã¨

 ÁÕ¤ÇÒÁÃٌÊÖ¡ÍÂÒ¡ª‹ÇÂà¼Å×Í

 à¡çº¤ÇÒÁÅѺ

º·ÊÃØ»

´ÙáÅÊØ¢ÀÒ¾áÅÐʹ㨻˜­ËÒªÕÇÔµ µÃÐ˹ѡ¶Ö§ÍÒÃÁ³áÅФÇÒÁÃٌÊÖ¡

* àÁ×è;º»˜­ËÒ  ÇÒ§á¹Ç·Ò§ª‹ÇÂàËÅ×Í

* ÇÔà¤ÃÒÐˏáÅÐNjҤÇÃ㪌·ÄÉ®Õã´

* àÅ×Í¡»ÃÐàÀ·¡ÒÃãˌ¡ÒûÃÖ¡ÉÒ

º··´Êͺ

1. ÇÑÂÃ؋¹ªÒÂ໚¹ä¢ŒÁÒ Ã¾. ᵋºÍ¡á¾·ÂÇ‹Ò¡ÅÑǵԴàª×éÍ HIVà¾ÃÒÐä»à·ÕèÂǼٌ˭ԧÁÒ áÅÐäÁ‹ä´ŒãªŒ

¶Ø§Âҧ͹ÒÁѨ֧¢ÍµÃǨ HIVáÅÐNjҶŒÒ໚¹¨Ð¦‹ÒµÑǵÒÂ

¤ÇÃ㪌·ÄÉ®Õã´ áÅÐ ¤ÇÃ㪌ËÅÑ¡ã´ã¹¡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ

- cognitive behavior gestalt-therapy

- information education supportive
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º··Õè 4 : ¡ÒôÙáÅ·Ò§¨ÔµÊѧ¤ÁÃÒºؤ¤ÅáÅФÃͺ¤ÃÑÇ

Common Personality Traits

 ºØ¤ÅÔ¡ÀÒ¾â´Â·ÑèÇä»ãªŒÍ¸ÔºÒ¾ĵԡÃÃÁ¢Í§¤¹æ ˹Ö觷ÕèÊѧࡵàËç¹ËÃ×Í໚¹ÊÔ觷Õ褹æ¹Ñé¹Í¸ÔºÒÂ
µ¹àͧàÁ×èÍÁͧµÒÁ»ÃÐʺ¡Òó·Õ輋ҹÁÒ

 ¤¹·ÕèÁÕ personality disorders ʋǹãË­‹ÁÑ¡»¯Ôàʸ¡ÒÃÃÑ¡ÉÒáÅÐäÁ‹ÂÍÁÃѺNjҵ¹àͧÁÕ»˜­ËÒ

 ÅѡɳТͧ¤¹·ÕèÁպؤÅÔ¡ÀÒ¾¼Ô´»¡µÔ¤×Í alloplastic (µŒÍ§¡ÒûÃѺáÅÐà»ÅÕè¹ÊÔè§áǴŌÍÁÃͺµÑÇ

ãˌࢌҡѺµ¹àͧ), áÅÐ ego-syntonic (äÁ‹ÃٌÊ֡NjҾĵԡÃÃÁ¢Í§µ¹àͧ໚¹»˜­ËÒ) ¤¹àËŋҹÕé¨Ö§
äÁ‹ä´ŒÃٌÊÖ¡¡Ñ§ÇÅà¡ÕèÂǡѺ¾ÄµÔ¡ÃÃÁ·ÕèäÁ‹´Õ¢Í§µ¹

ºØ¤ÅÔ¡ÀҾẺµ‹Ò§æ

1. Paranoid Person ¤¹¢ÕéÃÐáǧ

2. Withdrawn Person ¼ÙŒ»†ÇÂÊѹâ´É
3. Aggressive Person ¼ÙŒ»†Ç¡ŒÒÇÌÒÇ
4. Dramatic Person ¼ÙŒ»†ÇÂÌÍÂÅÕÅÒ
a. ¼ÙŒ»†Ç·ÕèÍÒÃÁ³á»Ã»Ãǹ§‹ÒÂËÃ×ÍËعËѹ¾Åѹáŋ¹
b. ¼ÙŒ»†Ç antisocial
c. ¼ÙŒ»†Ç histrionic
5. Dependent Person ¼ÙŒ»†ÇµԴ˹ֺ
6. Obsessional Person (perfectionist)
7. Passive-aggressive Person “¡ç㪋ŋÐËÁÍ..ᵋNjÒ..”
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compliance ËÁÒ¶֧¡ÒÃÁÒÃѺ¡ÒÃÃÑ¡ÉÒÍ‹ҧµ‹Íà¹×èͧ ÊÁèíÒàÊÁÍ ¡Ô¹ÂÒ¶Ù¡µŒÍ§

¡Ò÷íÒ¹Ò non-adherence

 ÍÂً¤¹à´ÕÂÇ äÁ‹Áռٌ´ÙáÅ

 ¡ÒÃÃÑ¡ÉÒ·Õè䴌ÃѺÁռŢŒÒ§à¤Õ§ÁÒ¡

 ÇÔ¸Õ¡ÒÃÃÑ¡ÉҫѺ«ŒÍ¹ÁÒ¡

 µŒÍ§ÃѺ¡ÒÃÃÑ¡ÉÒ (â´Â੾ÒСԹÂÒ) ÂÒǹҹ

 ÁÕ»ÃÐÇѵÔäÁ‹Ã‹ÇÁÁ×Í㹡ÒÃÃÑ¡ÉÒÁÒ¡‹Í¹

µÑÇÍ‹ҧ¡ÒÃᡌ»˜­ËÒ

1. Paranoid Person ¤¹¢ÕéÃÐáǧ

¡ÒôÙáżٌ»†Ç¢ÕéÃÐáǧ

 ÃѺ¿˜§ã¹ÊÔ觷ÕèÃÐáǧËÃ×͡ѧÇŠࢌÒ㨤ÇÒÁ¡Ñ§ÇŢͧ¼ÙŒ»†ÇÂ

 ÂÍÁÃѺ¤ÇÒÁàª×èÍáÅФÇÒÁÃÐáǧ¢Í§¼ÙŒ»†ÇÂ

 ºÍ¡à»‡ÒËÁÒ¢ͧ¡ÒÃÃÑ¡ÉÒãˌªÑ´à¨¹áÅÐ໚¹»ÃÐ⪹µ‹Í¼ÙŒ»†ÇÂáÅÐᾷ´ŒÇÂã¹àÇÅÒà´ÕÂǡѹ

 ͸ԺÒ·ءÊÔ觷ءÍ‹ҧ,ãˌàÍ¡ÊÒÃà¡ÕèÂǡѺâäáÅСÒÃÃÑ¡ÉÒ

 ¨´ºÑ¹·Ö¡·Ø¡¤ÃÑ駻‡Í§¡Ñ¹¡Òÿ‡Í§ÃŒÍ§

 ª‹ÇÂàËÅ×Í੾Ò똭ËÒã¹¢³Ð¹Õé෋ҹÑé¹

 àÅÕ觡Ò÷íÒ¡Å؋Á, »ÃÐàÁÔ¹¾ÄµÔ¡ÃÃÁ¡ŒÒÇÌÒÇ·Õè໚¹ÍѹµÃÒÂ
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2. Withdrawn Person ¼ÙŒ»†ÇÂÊѹâ´É

¡ÒôÙáżٌ»†ÇÂÊѹâ´É

 ¼ÙŒ»†ÇÂÁÑ¡¨ÐäÁ‹ÃÑ¡ÉÒ äÁ‹ÁÒµÒÁ¹Ñ´

 ¡ÒÃÊÌҧ¤ÇÒÁÊÑÁ¾Ñ¹¸ÊíҤѭÁÒ¡

 ᾷµŒÍ§·¹¤ÇÒÁà§Õº¹Ò¹æ䴌 ·¹¤ÇÒÁàº×èÍ䴌 áÅÐࢌÒ㨤ÇÒÁÃٌÊÖ¡¢Í§¼ÙŒ»†Ç·ÕèÅíÒºÒ¡àÁ×è͵ŒÍ§

àŋÒÍÒ¡ÒÃ

 Í‹ҾÂÒÂÒÁá¹Ð¹íÒãˌ¼ÙŒ»†ÇÂà»ÅÕ蹺ؤÅÔ¡ËÃ×ÍࢌÒÊѧ¤ÁãˌÁÒ¡æ ᵋ¡çµŒÍ§äÁ‹Êѹâ´ÉµÅÍ´ ઋ¹

á¹Ð¹íÒã¹à¢ŒÒËÇÁªÁÃÁ¢Í§¤¹·ÕèªÍº¤ÅŒÒÂæ¡Ñ¹

3. Aggressive Person ¼ÙŒ»†Ç¡ŒÒÇÌÒÇ

à·¤¹Ô¤¡ÒôÙáżٌ»†Ç¡ŒÒÇÌÒÇãˌàÃÒ»ÅÍ´ÀÑÂ

 Í‹ÒËѹËÅѧãˌ¼ÙŒ»†ÇÂà´ç´¢Ò´

 »Å‹ÍÂãˌ¼ÙŒ»†Ç¾ٴ Í‹ҢѴ¤Í

 ÁͧËҷҧ˹Õänjᵋà¹Ôè¹æ àµÃÕÂÁ·Ò§änj´ŒÇÂ

 à¡çº¢Í§·ÕèÍÒÇظ䴌 ·íÒãˌÊÀÒ¾áǴŌÍÁ»ÅÍ´ÀÑ·ÕèÊØ´

 Í‹ҷíÒµÑÇ໚¹ÎÕâË

 Í‹ҾÂÒÂÒÁࢌÒ任ŴÍÒÇظ¼ÙŒ»†Ç ¶ŒÒ¼ÙŒ»†Çº͡NjÒÁÕÍÒÇظãˌàª×èÍänj¡‹Í¹áŌÇ˹շѹ·Õ áŌÇᨌ§

਌Ò˹ŒÒ·ÕèÍ×è¹
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¡Ã³Õ˹ÕäÁ‹ä´Œ

 ¹Ôè§änj¡‹Í¹ Í‹ҡÃÐⵡ¡Ãеҡ

 ¾ÂÒÂÒÁ¢Í¤ÇÒÁª‹ÇÂàËÅ×Í෋ҷÕè·íÒ䴌

 Í‹ÒࢌÒä»»ÅéíҡѺ¼ÙŒ»†ÇÂ

 µÑ駷‹Òãˌ´ÙäÁ‹¤Ø¡¤ÒÁ¼ÙŒ»†Ç ઋ¹ à¼Â½†ÒÁ×ÍãˌàË繪Ѵਹ Â×¹·íÒÁØÁ 45 ͧÈÒ Å´¡ÒÃʺµÒŧ

 Â×¹Êѧࡵ àµÃÕÂÁ¾ÃŒÍÁ»‡Í§¡Ñ¹µÑÇ

 ·íÒµÒÁ·Õè¼ÙŒ»†ÇµŒÍ§¡ÒÃ෋ҷÕè·íÒ䴌 Í‹Òà¾Ô觢Ѵ㨠»Å‹ÍÂãˌ¾Ù´´Õ¡Ç‹Òãˌ·íÒ

 àÁ×èÍʧº ¾ÂÒÂÒÁãˌ¼ÙŒ»†ÇÂÇÒ§ÍÒÇظ ¾Ù´¤ØÂÍ‹ҧࢌÒã¨

 ¶ŒÒ¼ÙŒ»†Ç¨ÐࢌÒâ¨ÁµÕ ãˌËÒà¿ÍϹÔà¨ÍÏËÃ×ͧ͢ÃͺµÑÇÁÒ»‡Í§¡Ñ¹µÑÇàͧ

 ˹շѹ·ÕàÁ×èÍÁÕâÍ¡ÒÊáÅлÅÍ´ÀÑÂà¾Õ§¾Í

4. Dramatic Person ¼ÙŒ»†ÇÂÌÍÂÅÕÅÒ

¡ÒôÙáżٌ»†Ç·ÕèÍÒÃÁ³á»Ã»Ãǹ§‹ÒÂ

 ᨌ§ãˌ·ÃÒº¶Ö§¢Íºà¢µ¡ÒôÙáŢͧᾷ ઋ¹ á¼¹¡ÒÃÃÑ¡ÉÒ ¢ŒÍµ¡Å§ã¹¡ÒÃÃÑ¡ÉÒ ¡ÒùѴ ¡ÒÃ

´ÙáÅàÁ×èÍà¡Ô´¼Å¢ŒÒ§à¤Õ§¨Ò¡¡ÒÃÃÑ¡ÉÒ â´ÂµŒÍ§ä´ŒÃѺ¤íÒÂÔ¹ÂÍÁËÇÁ¡Ñ¹ÃÐËNjҧ¼ÙŒ»†ÇÂáÅÐᾷ áÅÐ
·íÒÍ‹ҧâ»Ã‹§ãÊ
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¡ÒôÙáżٌ»†Ç antisocial

 ¶ÒÁãˌªÑ´à¨¹Ç‹ÒÊÔè§ä˹·Õè¼ÙŒ»†ÇµŒÍ§¡ÒÃãˌª‹ÇÂàËÅ×Í

 ¶ÒÁ¢ŒÍÁÙÅãˌÁÒ¡æà¾×èÍãˌࢌÒã¨ä´Œ´Õ¢Öé¹ Í‹Òà¾Ôè§àª×èÍÊÔ觷Õè»ÃÒ¡¯µÃ§Ë¹ŒÒ µŒÍ§ËÒËÅÑ¡°Ò¹ÁÒ¾ÔÊÙ¨¹

¤ÇÒÁ¹‹Òàª×èÍ´ŒÇÂ

 µÑé§à»‡Ò¡ÒäØÂà¾×èÍÊÌҧ¤ÇÒÁÊÑÁ¾Ñ¹¸·Õè´ÕáÅÐàª×èÍã¨ä´Œµ‹Í¡Ñ¹

 ÁբͺࢵªÑ´à¨¹ã¹¡ÒôÙáÅ

 äÁ‹µŒÍ§¾ÂÒÂÒÁÃÑ¡¤¹¡Å؋Á¹Õé à¾ÃÒÐà¢Ò¨ÐäÁ‹¹‹ÒÃÑ¡ÍÂًáŌÇâ´Â¸ÃÃÁªÒµÔ ᵋµŒÍ§à¢ŒÒã¨ÊÔ觷Õèà¢Ò·íÒãˌ䴌

 äÁ‹µŒÍ§¾ÂÒÂÒºà»ÅÕ蹤¹¡Å؋Á¹Õé Áѹà»ÅÕè¹äÁ‹ä´Œ

¡ÒôÙáżٌ»†Ç histrionic

 ÍÂ‹Ò reward ãˌ¡Ñº¾ÄµÔ¡ÃÃÁ histrionic

 ·íÒ໚¹äÁ‹Ê¹ã¨

 ÊíÒÃǨ·‹Ò·Õ¢Í§µÑÇàͧNjÒä»ÂÑèÇÂǹ¡‹Í¹ËÃ×Íà»Å‹Ò

 áÊ´§Ê¶Ò¹Ð¤ÇÒÁ໚¹á¾·Â¢Í§µ¹àͧÍ‹ҧªÑ´à¨¹

 ແ´»ÃеٷÔé§änj

 ¶ŒÒÂѧäÁ‹ä´Œ¼Åãˌ¢ÍµÑÇÍÍ¡¨Ò¡ËŒÍ§ ËÃ×ÍàªÔ­ãˌ¼ÙŒ»†ÇÂÍÍ¡

5. Dependent Person ¼ÙŒ»†ÇµԴ˹ֺ

¡ÒôÙáÅ Dependent Person

 ÇҧἹ¡ÒÃÃÑ¡ÉÒÍ‹ҧ໚¹¢Ñé¹à»š¹µÍ¹ ÁըشÁ؋§ËÁÒÂáÅЪѴਹ ÁըشÊÔé¹ÊØ´·ÕèªÑ´à¨¹

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 Set limits and rules

 Í‹ҵѴÊÔ¹ã¨á·¹ ᵋ¡Ãе،¹ã¹¼ÙŒ»†ÇµѴÊÔ¹ã¨àͧ

 á¹Ð¹íÒãˌ´ÙáŵÑÇàͧ ËÒÊѧ¤Á¢Í§µÑÇàͧÁÒ¡¢Öé¹

 ãˌ insight áÅШРreassure àÁ×èͨíÒ໚¹¨ÃÔ§æ

 àÍÒ¤ÇÒÁÃٌÊÖ¡¹ÕéÁÒ㪌ãˌ໚¹»ÃÐ⪹µ‹Í¡ÒÃÃÑ¡ÉÒ

6. Obsessional Person

¡ÒôÙáÅ Obsessional Person

 »ÃÖ¡ÉÒá¼¹¡ÒÃÃÑ¡ÉҡѺ¼ÙŒ»†ÇÂà¾ÃÒШÐ਌ҡÕé਌ҡÒÃ

 ¾ÂÒÂÒÁª‹ÇÂã¹áºº·Õèà¢Ò໚¹ÁÒ¡¡Ç‹Ò¨Ðà»ÅÕ蹺ؤÅÔ¡à¢Ò

 ãˌ¤íÒá¹Ð¹íÒ·ÕèªÑ´à¨¹

 á¹Ð¹íÒãˌÊѧࡵµÑÇàͧàÁ×èÍà¡Ô´¤ÇÒÁ¡Ñ§ÇÅ¢Öé¹

 àÁ×èÍÁÕ»˜­ËÒÁÒ¡¢Ö鹼ٌ»†Ç¨СѧÇÅÁÒ¡ ¶×Í໚¹Åѡɳл¡µÔ¢Í§¤¹áºº¹Õé ãˌáÊ´§¤ÇÒÁÃٌÊÖ¡

ÍÍ¡ÁÒ䴌

7. Passive-aggressive Person “¡ç㪋ŋÐËÁÍ..ᵋNjÒ..”

¡ÒôÙáÅ Passive-aggressive Person

 ·º·Ç¹»ÃÐÇѵԡÒÃÃÑ¡ÉÒáŌÇÇÔà¤ÃÒÐˏNjÒÇÔ¸Õ·Õ輋ҹÁÒ ·íÒäÁ‹äÁ‹àÇÔϤ

 µÃ§ä»µÃ§ÁÒáÅШÃÔ§ã¨

 ºÍ¡¼ÅàÊÕ·ÕèÍÒ¨à¡Ô´¢Ö鹨ҡ¡ÒáÃзíҢͧ¼». ઋ¹ ¼Ô´¹Ñ´

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 ÊíÒÃǨ¤ÇÒÁ˧ش˧Դ¢Í§µÑÇᾷàͧ

¡ÒÃᡌ»˜­ËÒ·ÕèÍÒ¨¨Ðà¨Í䴌㹡ÒôÙáÅÃÑ¡ÉҼٌ»†ÇÂ

1. ¡Ã³Õ¼ÙŒ»†ÇÂâ¡Ã¸

 ÃѺÃٌ¤ÇÒÁâ¡Ã¸¢Í§¼ÙŒ»†Ç·Õèà¡Ô´¢Öé¹ Í‹Ò˹Õ

 Í‹Òâ¡Ã¸¡ÅѺ

 ãˌàÇÅҼٌ»†ÇÂʧºÊµÔÍÒÃÁ³ÍÂً¤¹à´ÕÂÇÊÑ¡¤Ãً¶ŒÒ¨íÒ໚¹

2. ¡Ã³Õ¼ÙŒ»†ÇÂÂÑèÇÂǹ

 Í‹ÒÂÑèÇÂǹ¡ÅѺ

 ¾ÂÒÂÒÁäÁ‹Ê¹ã¨¾ÄµÔ¡ÃÃÁ¹Ñè¹

 ¤Çº¤ØÁÍÒÃÁ³áÅÐËҧ¡ÒÂ

 ແ´»ÃеÙänj

 Â×¹Âѹ¤ÇÒÁÊÑÁ¾Ñ¹¸Ç‹Ò໚¹à¾Õ§ᾷáÅмٌ»†ÇÂ

 Í‹һ¯ÔàʸÍ‹ÒÍÍ¡¹Í¡Ë¹ŒÒËÃ×ÍáÊ´§·‹Ò·Õè´Ù¶Ù¡ËÂÒº¤Ò¡ÅѺ

3. ¡Ã³Õ¼ÙŒ»†ÇÂàÃÕ¡ÌͧÁÒ¡

 ·íÒ¤ÇÒÁࢌÒ㨡Ѻ¼ÙŒ»†ÇÂNjÒÊÔè§ä˹ᾷ·íÒ䴌 ÊÔè§ä˹äÁ‹ä´Œ

 ࢌÒ㨤ÇÒÁÃٌÊÖ¡¢Í§¼ÙŒ»†Ç (¼Ô´ËÇѧËÃ×Íâ¡Ã¸)

 ãˌ·Ò§àÅ×Í¡Í×è¹á¡‹¼ÙŒ»†Ç´ŒÇÂ

4. ¡Ã³Õ¼ÙŒ»†ÇÂÍÂÒ¡ÃٌÍÂÒ¡àËç¹
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 ઋ¹µŒÍ§¡ÒÃÃٌ¨Ñ¡á¾·Âà»š¹¡ÒÃʋǹµÑÇ

 ºÍ¡Ç‹Ò “ËÁÍÁÕàÇÅÒ´ÙáŤسà¾Õ§ÊÑé¹æ«Öè§ËÁÍÍÂÒ¡¨ÐãˌàÇÅҡѺ¡ÒÃÃÑ¡ÉҤسÍ‹ҧàµçÁ·Õè
ÁÒ¡¡Ç‹Ò¤ØÂàÃ×èͧ¢Í§ËÁÍ”

 ËÃ×ͶÒÁ¡ÅѺ “ÊÒÁբͧËÁÍʺÒ´դ‹Ð áŌÇÀÃÃÂҤس໚¹Âѧ䧺ŒÒ§”

 ËÃ×͵ͺ»¯ÔàʸÍ‹ҧÊØÀÒ¾ “¢Íâ·É¤‹Ð ᵋâ´Â»¡µÔËÁͨÐäÁ‹¾Ù´¤ØÂàÃ×èͧʋǹµÑÇ¢³ÐÍÂً

ã¹ËŒÍ§µÃǨ”

5. ¼ÙŒ»†ÇÂäÁ‹àª×èÍNjҵ¹àͧµŒÍ§ÃѺ¡ÒÃÃÑ¡ÉÒ

 ãˌ education à¡ÕèÂǡѺâäáÅСÒÃÃÑ¡ÉÒ

 ÃѺ¿˜§¤ÇÒÁ¡ÅÑÇáÅФÇÒÁàª×èͧ͢¼ÙŒ»†ÇÂà¡ÕèÂǡѺ¡ÒÃÃÑ¡ÉÒ áÅÐᡌä¢ãˌ¶Ù¡µŒÍ§ã¹ÊÔ觷ÕèäÁ‹ÁÕ
à˵ؼÅ

 àªç¤¤ÇÒÁࢌÒã¨â´Âãˌ͸ԺÒÂNjÒÍÒ¡Òâͧµ¹àͧ໚¹Í‹ҧäÃ

6. ¼ÙŒ»†ÇÂäÁ‹à¢ŒÒ㨤íÒá¹Ð¹íÒ

 ¡Ãе،¹ãˌ¶ÒÁ

 ͸ԺÒ«éíÒËÅÒÂæÃͺ áÅжÒÁ¼ÙŒ»†ÇÂà¾×èÍãˌÅͧ͸ԺÒ¡ÅѺ ¶ŒÒÂѧäÁ‹à¢ŒÒ㨡ç͸ԺÒÂÍÕ¡

 ãˌ¢ŒÍÁÙÅ·ÕèàËç¹ÀÒ¾ ઋ¹ à¢Õ¹ãˌ´Ù

 ãˌ¡ÒÃÃÑ¡ÉÒ·Õè¨íÒ§‹ÒÂæ

7. ¼ÙŒ»†ÇÂÅíҺҡ㨷Õè¨ÐÃѺ¡ÒÃÃÑ¡ÉÒ

 ¤Œ¹ËÒNjÒà¾ÃÒÐÍÐäè֧ÅíÒºÒ¡ã¨

 ÊÌҧ¤ÇÒÁÊÑÁ¾Ñ¹¸Íѹ´Õµ‹Í¡Ñ¹
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 27

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 ª×蹪ÁàÁ×èͼٌ»†ÇÂÊÒÁÒö»¯ÔºÑµÔµÒÁ¤íÒá¹Ð¹íÒ䴌´Õ

 ÍÒ¨µŒÍ§ä»àÂÕèÂÁºŒÒ¹

8. ¼ÙŒ»†ÇÂÅ×Á¹Ñ´ËÃ×ÍÅ×Á¡Ô¹ÂÒ

 ãˌ㺹Ѵ â·ÃËÃ×ͨ´ËÁÒÂàµ×͹àÁ×èÍã¡ÅŒÇѹ¹Ñ´

 ¨Ñ´ÂÒãˌàª×èÍÁ⧡Ѻ¡Ô¨ÇѵûÃШíÒÇѹ

 µÑé§àÇÅÒ»ÅØ¡àÁ×è͵ŒÍ§¡Ô¹ÂÒ

 »ÃѺÂÒãˌÍÂًã¹ÃÙ» long acting

 ãˌà¢Õ¹⹌µàµ×͹änj㹷Õè·ÕèàËç¹à»š¹»ÃШíÒ àª‹¹ µÙŒàÂç¹

9. ¼ÙŒ»†Ç¨‹Ò¤‹ÒÂÒäÁ‹äËÇ

 ËÒÂÒµÑÇÍ‹ҧ ÂÒ¿ÃÕ ËÃ×Íá¹Ð¹íÒ˹‹Ç§ҹ·Õ誋ÇÂàËÅ×Í䴌

 ËÒÂÒÍ×è¹·Õè¶Ù¡¡Ç‹Ò

10. ÂÒ·íÒãˌà¡Ô´¼Å¢ŒÒ§à¤Õ§

 »ÃѺ໚¹ÂÒÍ×è¹·ÕèÁռŢŒÒ§à¤Õ§¹ŒÍÂ¡Ç‹Ò ËÃ×Í»ÃѺ¢¹Ò´ÂÒãˌàËÁÒÐÊÁ

 ÃÑ¡ÉҼŢŒÒ§à¤Õ§

11. äÁ‹ÁÒà¾ÃÒ똭ËÒ·ÕèµÑǺؤ¤ÅÒ¡ÃËÃ×ͺÃÔ¡ÒÃ

 ËÒµŒ¹à˵آͧ»˜­ËÒãˌà¨Í

 µÃǨ´ÙNjҡÒÃÃÑ¡ÉÒ·Õè䴌àËÁÒÐÊÁËÃ×ÍäÁ‹

 ÊÌҧ¤ÇÒÁÊÑÁ¾Ñ¹¸Íѹ´Õ ¶ŒÒÂѧäÁ‹ä´ŒµŒÍ§à»ÅÕè¹ᾷ
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 28

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 ÂÔ¹´ÕµŒÍ¹ÃѺàÊÁÍ äÁ‹¡´´Ñ¹¼ÙŒ»†ÇÂ

 Â×´ËÂ؋¹ä´Œ à¤Òþã¹ÊÔ·¸Ô¢Í§¼ÙŒ»†ÇÂ

12. ¼ÙŒ»†ÇÂÁÕà˵ؼŷҧÊѧ¤Á·íÒãˌäÁ‹ adherence

 ઋ¹ÃٌÊ֡໚¹ stigma ¤Ãͺ¤ÃÑÇäÁ‹ÍÂÒ¡ãˌÃÑ¡ÉÒ äÁ‹àª×èÍ㨠µÔ´§Ò¹¨Ö§ÁÒäÁ‹ä´Œ

 ËÒÊÒà˵آͧ»˜­ËÒ

 Educate ¢ŒÍ´Õ¢ŒÍàÊÕ¢ͧ¡ÒÃÃÑ¡ÉÒ

 »ÃѺÃٻẺ¡ÒÃÃÑ¡ÉÒ

 á¹Ð¹íÒ¤ÅÔ¹Ô¡¹Í¡àÇÅÒ

 »Åͺ㨭ҵԴŒÇÂ
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 29

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¡ÒôÙáżٌ»†ÇÂà´ç¡ÃÒºؤ¤Å·Ò§¨ÔµÊѧ¤Á ¤Ãͺ¤ÃÑÇ

à¡ÃÔè¹¹íÒ ¤íÒÈѾ··Õè¤ÇÃÃٌ

1. Disease ¤×Í ¡Ò÷ÕèËҧ¡ÒÂ(physiological)áÅШԵã¨(psychological)äÁ‹ÊÒÁÒö·íÒ˹ŒÒ·Õè䴌Í‹ҧ

»¡µÔʋ§¼Åµ‹Í¡ÒÃ㪌ªÕÇÔµ»ÃШíÒÇѹ
2. Illness ¤×Í ¡Òõͺʹͧµ‹Íâäæ˹Öè§ËÃ×ÍÍÒ¨¨Ð໚¹¡Òõͺʹͧµ‹ÍÊÔè§áǴŌÍÁËÃ×ͺؤ¤Å·Õè
¡‹Íãˌà¡Ô´¤ÇÒÁäÁ‹ÊºÒ¡ÒÂáÅÐ㨠«Öè§ÍÒ¨¨Ðà¡Ô´Ã‹ÇÁ¡Ñº disease ËÃ×ÍäÁ‹¡ç䴌 ઋ¹
depressive mood , major depression
3. Health ¤×ÍÀÒÇзÕè physical , psychological,social (&spiritual) = well being

¤ÇÒÁÃٌàº×éͧµŒ¹

¡Òû†Ç¢ͧà´ç¡¹Ñ鹨ÐÁÕàÃ×èͧ development ¢Í§à´ç¡à¢ŒÒÁÒà¡ÕèÂÇ¢ŒÍ§´ŒÇ äÁ‹Ç‹Ò¨Ð໚¹ fine motor

, gross motor, ÀÒÉÒ ÃÇÁ¶Ö§Êѧ¤ÁáÅзѡÉÐ㹡ÒÃᡌ»˜­ËÒ´ŒÇÂ

«Ö觡ÒôÙáÅàÍÒã¨ãʢͧ¾‹ÍáÁ‹áÅкؤ¤Å㹤Ãͺ¤ÃÑǹÑé¹ÁÕÍÔ·¸Ô¾Åµ‹ÍÍÒ¡ÒÃà¨çº»†Ç¢ͧà´ç¡à»š¹
Í‹ҧÁÒ¡ ËÒ¡¾‹ÍáÁ‹äÁ‹àÍÒã¨ãʋ¡ç¨Ð·íÒãˌÍÒ¡ÒÃà¨çº»†Ç¹Ñé¹·Ãش˹ѡ䴌

»˜¨¨Ñ·Õèʋ§¼Åµ‹Í¡Òõͺʹͧµ‹Í illness

1. Child rearing
2. Temperament
3. Environment â´Â੾ÒФÃͺ¤ÃÑÇ
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 30

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“àÁ×èͤÃͺ¤ÃÑÇâ´Â੾Òмٌ·ÕèàÅÕ駴Ùà´ç¡¹Ñé¹ËÒ¡à¡Ô´¤ÇÒÁà¤ÃÕ´¢Ö鹡ç¨Ðʋ§¼Åãˌ¡ÒÃáÊ´§ÍÍ¡ÁÒ¹Ñé¹á‹ŧ
(poor outcomes)äÁ‹Ç‹Ò¨Ð໚¹¡ÒÃàÅÕ駴Ùà´ç¡ËÃ×Í¡ÒÃàÍÒã¨ãʋà´ç¡¡çµÒÁ”
¡Òà approach ¼ÙŒ»†ÇÂà´ç¡

1. ¡Òëѡ»ÃÐÇѵÔáÅСÒõÃǨËҧ¡ÒÂ
2. ¡ÒûÃÐàÁÔ¹¾Ñ²¹Ò¡ÒÃáÅÐ function µ‹Ò§æ·Õèà»ÅÕè¹á»Å§ä»
3. ¡ÒûÃÐàÁÔ¹ family function
4. ¡ÒûÃÐàÁÔ¹¡Òõͺʹͧµ‹Í illness ¢Í§à´ç¡

ÊÔ觷Õè¤ÇÃÃٌ

1. ÊÔ觷Õèᾷ¤ÇèÐÃ،¡ç¤×ÍÇ‹Ò à´ç¡¨ÐäÁ‹ÊÒÁÒöÃѺÃٌ¤ÇÒÁËÁÒ·Õè᷌¨ÃÔ§¢Í§ illness â´Âà´ç¡¨ÐÃѺÃٌ¶Ö§

severe illness µÍ¹ÍÒÂØ 4 ¢Çº áÅШÐࢌÒ㨤ÇÒÁµÒÂàÁ×èÍÍÒÂØ 7 ¢Çº â´Âà´ç¡¨ÐࢌÒã¨
illness â´Â͌ÍÁæ ¨Ò¡¡ÒÃáÊ´§ÍÍ¡¢Í§¾‹ÍáÁ‹ËÃ×ͺؤ¤Å·ÕèàÅÕ駴٠´Ñ§¹Ñé¹ÊØ¢ÀÒ¾¢Í§¾‹ÍáÁ‹¹Ñ鹶×Í
໚¹Èٹ¡ÅÒ§áÅÐÁÕÍÔ·¸Ô¾Åµ‹Í¤ÇÒÁà¨çº»†ÇÂáÅФÇÒÁÃعáç¢Í§¤ÇÒÁà¨çº»†Ç¢ͧà´ç¡à»š¹Í‹ҧ
ÁÒ¡
2. ¤Ãͺ¤ÃÑÇ໚¹Ë¹‹Ç·ҧÊѧ¤Á·ÕèàÅç¡·ÕèÊØ´·Õè·íÒãˌà´ç¡º¹âš㺹Õéᵡµ‹Ò§¡Ñ¹ã¹´ŒÒ¹µ‹Ò§æäÁ‹Ç‹Ò¨Ð໚¹
àª×éÍªÒµÔ ÈÒÊ¹Ò ¡ÒÃͺÃÁàÅÕ駴٠ËÃ×ÍáÁŒ¡ÃзÑè§ ·Ñ¡ÉÐ㹡ÒÃÊ×èÍÊÒÃ
3. à´ç¡áµ‹ÅФ¹¨ÐÁÕ¤ÇÒÁᵡµ‹Ò§¡Ñ¹ã¹á§‹¢Í§¾×é¹°Ò¹·Ò§ÍÒÃÁ³(temperament) ºØ¤ÅÔ¡ÅѡɳÐ
¤ÇÒÁÊÒÁÒö㹡ÒÃàÃÕ¹Ãٌ
4. àÇÅÒ·Õ辋ÍáÁ‹ãˌ¡ÑºÅÙ¡ ¤ÇÒÁà¤ÃÕ´¢Í§¤Ãͺ¤ÃÑÇ Ê‹§¼Åµ‹Í¡ÒÃàÅÕ駴Ùà´ç¡·Ñ駹Ñé¹
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 31

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5. ¾×é¹°Ò¹·Ò§ÍÒÃÁ³¢Í§à´ç¡¹Ñé¹ÊÒÁÒöẋ§á¡ÅѡɳТͧà´ç¡ä´Œ â´ÂÊÒÁÒöẋ§à»š¹
a. Easy child 㹡ÒÃ㪌ªÕÇÔµ»ÃШíÒÇѹäÁ‹Ç‹Ò ¨Ð¡Ô¹ ¨Ð¹Í¹¡çÁÕ pattern ËÃ×ÍÃٻẺ
੾ÒÐã¹áµ‹ÅÐÇѹ ÍÒÃÁ³´Õ »ÃѺµÑÇ䴌´Õ áÅÐÊÒÁÒö·Õèᡌ䢻˜­ËÒµ‹Ò§æ䴌§‹ÒÂ
b. Slow to worm-up child àÃÕ¹Ãٌ¤‹Í¹¢ŒÒ§ªŒÒ µÍºÊ¹Í§ÊÔè§àÌÒãËÁ‹æ䴌ªŒÒ ÁÑ¡¨ÐÍÂ؋¹Ôè§æ
ºÒ§¤ÃÑ駡çÁÕ negative mood ºŒÒ§
c. Difficult child äÁ‹ÁÕ pattern (¡ÒáԹ ¡Òù͹) negative mood »ÃѺµÑǪŒÒ
áÅеͺʹͧµ‹ÍÍÒÃÁ³Í‹ҧÃعáç easy distracted (ÍÒÃÁ³à»ÅÕè¹á»Å§§‹ÒÂ
à´ÕèÂÇÍÒÃÁ³´Õ ¾ÍÍÐäÃÁҡǹ㨡ç¨Ðà»ÅÕè¹á»Å§§‹ÒÂ) health outcomes ¢Í§
difficult child ¹Ñé¹¢Öé¹ÍÂً¡ÑºÍÒÃÁ³áÅÐÊÔè§áǴŌÍÁ´ŒÇ ¹Ñé¹ËÁÒ¤ÇÒÁÇ‹Ò ¾‹ÍáÁ‹µŒÍ§ÁÕ
ÍÒÃÁ³áÅШԵ㨷Õè´Õ äÁ‹à¤ÃÕ´ ÊØ¢ÀÒ¾¢Í§ÅÙ¡¶Ö§¨Ð´Õ àÃÕÂ¡Ç‹Ò “goodness-of-fit”
6. àÁ×èÍà´ç¡»†Ç¾‹ÍáÁ‹äÁ‹¤ÇõÒÁã¨ÁÒ¡à¾ÃÒÐÍÒ¨¨Ð·íÒãˌà¡Ô´»˜­ËÒµÒÁÁÒ䴌ઋ¹ µÒÁ㨹ŒÍ§ÁÒ¡ä»
¾ÕèÍÒ¨¨ÐÃٌÊÖ¡¹ŒÍÂ㨠¾‹ÍáÁ‹äÁ‹ÃÑ¡ µÑǹŒÍ§¡ç¨ÐÃٌÊÖ¡¾‹ÍáÁ‹µÒÁã¨ÂÔè§ä»¡Ñ¹ãË­‹
7. Illness ¨Ð·íÒãˌÍÒÃÁ³¢Í§à´ç¡á‹ŧËÃ×ÍäÁ‹¡ç¢Öé¹ÍÂً¡ÑºÍÒÂآͧà´ç¡´ŒÇ Í‹ҧäáçµÒÁ illness
‹ÍÁ·íÒãˌà¡Ô´ difficult emotion ¢Öé¹ä´Œ
8. ÊÃØ» ¾‹ÍáÁ‹¨ÐàÅÕ駴ÙáÅдÙáÅà´ç¡ä´Œ´Õ¹Ñé¹µŒÍ§ÍÒÈѤÇÒÁª‹ÇºàËÅ×ͨҡÊѧ¤Á´ŒÇÂáÅо‹ÍáÁ‹¡çµŒÍ§
ÊØ¢ÀÒ¾´Õ´ŒÇ¨֧¨Ð·íÒãˌ¡ÒôÙáÅàÍÒã¨à´ç¡¹Ñé¹»ÃÐʺ¤ÇÒÁÊíÒàÃç¨
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 32

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º··Õè 5 ¡ÒûÃÐàÁÔ¹¼ÙŒÊÙ§ÍÒÂØÍ‹ҧ¤Ãͺ¤ÅØÁ
(Comprehensive Geriatric Assessment)
»ÃЪҡüٌÊÙ§ÍÒÂØ

¤íÒ¨íÒ¡Ñ´¤ÇÒÁ

ͧ¤¡ÒÃ͹ÒÁÑÂâÅ¡ > 60 »‚

ÂØâûáÅÐÍàÁÃÔ¡Òà˹×Í > 65

¼ÙŒÊÙ§ÍÒÂØÇѵ‹Ò§ æ

Ã؋¹àÂÒǏ(young old) 60-75 »‚

Ã؋¹¡ÅÒ§(medium old) 75-85 »‚

Ã؋¹ãË­‹(old-old) > 85 »‚

ẋ§µÒÁÀÒÇÐÊØ¢ÀÒ¾

1. ÊØ¢ÀÒ¾´Õ
2. ÁÕâäàÃ×éÍÃѧáÅÐ/ËÃ×ÍÁÕÀÒÇзؾ¾ÅÀÒ¾
3. ˧‹ÍÁ/§ÍÁ/ºÍººÒ§/frail elderly

ẋ§µÒÁ¡ÒþÖ觾ҼٌÊÙ§ÍÒÂØ

1. äÁ‹µŒÍ§¾Ö觾ÒàÅ – totally independence

2. ¾Ö觾Һҧʋǹ – partially dependence
3. ¾Ö觾ҷÑé§ËÁ´ – totally dependence
4. µÔ´àµÕ§ – bed ridden
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 33

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Ten Leading Illness among the Elderly by Sex in Thailand 1992

Back pain 17.7 %

Hypertension 13.9%

Peptic ulcer 12.0 %

Arthritis 8.8 %

Heart disease 6.1 %

Diabetes 5.3 %

Asthma 3.8 %

Muscular pain 2.5 %

Common cold 2.1 %

Kidney stone 1.8%

ÅѡɳÐ੾ÒТͧ¼ÙŒÊÙ§ÍÒÂØ

• ÁÒ¡»˜­ËÒ (ËÅÒÂâä ËÅÒ¾ÂÒ¸ÔÊÀÒ¾)

• äÁ‹ÃٌÊÒà赯 (ÍÒ¡ÒÃáÅÐÍÒ¡ÒÃáÊ´§äÁ‹¨íÒà¾ÒÐ)

• ·ÃشŧàÃçÇ

• âäá·Ã¡§‹ÒÂ

• ¿„œ¹µÑǪŒÒ
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 34

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• ÍÒ¡ÒùíÒ·ÕèäÁ‹à©¾ÒÐ : ¡ÒÃà¨çº»†ÇÂà©Õº¾ÅѹËÃ×Íà¨çº»†ÇÂàÃ×éÍÃѧÍÒ¡ÒùíÒÁÑ¡¨ÐäÁ‹
ṋ¹Í¹ (vague) äÁ‹à©¾ÒÐËÃ×Í´ÙNjÒÍÒ¡ÒÃàÅ硹ŒÍÂ

• ÍÒ¡ÒÃáÅÐÍÒ¡ÒÃáÊ´§à©¾ÒÐÍÒ¨äÁ‹ÁÕËÃ×ÍÁÕᵋà¡Ô´ªŒÒ

• ÊÁͧÁÕ¤ÇÒÁà»ÃÒкҧµ‹Í¤ÇÒÁà¨çº»†Ç¨֧à¡Ô´¡ÒÃà»ÅÕè¹á»Å§¢Í§¡ÒÃÃٌ¤Ô´ ËÃ×ÍÍÒÃÁ³«Öè§
໚¹ nonspecific sign of illness

• ÁÕ¤ÇÒÁËÅÒ¡ËÅÒ·Ñé§ã¹Ê‹Ç¹¢Í§ÍÒÂØ ÊÀҾËҧ¡Ò ÅѡɳШԵ㨠¾ÅѧÊíÒÃͧ âä

»ÃШíÒµÑÇ·ÕèÍÍ¡ÍÒ¡Òà áÅÐáͺὧ ÃдѺ¤ÇÒÁÃٌ ¡ÒÃÈÖ¡ÉÒ ÅѡɳзҧÊѧ¤Á ÃдѺ¡ÒÃ
¾Ö觾ԧ ÊÀÒ¾¤Ãͺ¤ÃÑÇáÅЪØÁª¹

• ÍÒ¡Ò÷ҧ¤ÅÔ¹Ô¡äÁ‹ªÑ´à¨¹

• âä·Ò§Ã‹Ò§¡ÒÂᵋÍÍ¡ÍÒ¡ÒäŌÒÂâä¨Ôµâä»ÃÐÊÒ·

• âä·Ò§¨Ôµã¨áµ‹ÍÍ¡ÍÒ¡Ò÷ҧ´ŒÒ¹Ã‹Ò§¡ÒÂ

• ¾ÅѧÊíÒÃͧáÅФÇÒÁÊÒÁÒö¢Í§Ã‹Ò§¡Ò¶´¶ÍÂàÃ×èÍÂ æ ·íÒäÁÍÒ¡ÒùíҢͧ¡ÒÃà¨çº»†ÇÂã¹
¼ÙŒÊÙ§ÍÒÂب֧äÁ‹àËÁ×͹·ÑèÇä»

·íÒäÁÍÒ¡ÒùíҢͧ¡ÒÃà¨çº»†ÇÂ㹼ٌÊÙ§ÍÒÂب֧äÁ‹àËÁ×͹·ÑèÇä»

 ¡Ãкǹ¡ÒÃà»ÅÕè¹á»Å§¢Í§Ãкº»ÃÐÊÒ·
 ਵ¤µÔàªÔ§Åº ÂÍÁÃѺ
 Í´·¹àÍÒáÅÐà¾ÃÒÐÊÙ§ÍÒÂØ͸ԺÒÂäÁ‹ä´Œ (ᾷ)
 ¡ÅÑÇ (¹Í¡à˹×ͨҡ¤ÇÒÁà¨çº»†Ç¤×Íà¢ŒÒ Ã¾.)
 äÁ‹àÍÒã¨ãʋ ÅÐàÅ (ignorance)
 ¤ÇÒÁàÊ×èÍÁ¢Í§Ãкº»ÃÐÊÒ· (¤ÇÒÁ»Ç´Å´Å§)
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 35

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¼ÙŒÊÙ§ÍÒÂØʋǹãË­‹ÁÕ»˜­ËÒÊØ¢ÀÒ¾ËÅÒÂÃкº

ÊÒà˵Ø

 ¾ÄµÔ¡ÃÃÁáÅÐÊÔè§áǴŌÍÁ
 ÇÔ¶Õ¡ÒôíÒà¹Ô¹ªÕÇÔµ
 ¾Ñ¹¸Ø¡ÃÃÁ

¡ÒûÃÐàÁÔ¹ÀÒÇÐÊØ¢ÀÒ¾¼ÙŒÊÙ§ÍÒÂØ ÁÕ¤ÇÒÁ੾ÒÐáÅÐᵡµ‹Ò§¨Ò¡¼ÙŒãË­‹·ÑèÇä»

 ÁÕ¤ÇÒÁᵡµ‹Ò§¡Ñ¹ã¹¡Å؋ÁÊÙ§ (heterogeous group)

 ¶Ù¡ÁͧNjÒ໚¹ÇÑÂàÊ×èÍÁ áÅдŒÍÂÊÁÃöÀÒ¾µŒÍ§¾Ö觾ҼٌÍ×è¹ ¼ÙŒÊÙ§ÍÒÂب֧ÁÑ¡¶Ù¡ÅÐàÅ»˜­ËÒÊØ¢ÀÒ¾·Õè
»‡Í§¡Ñ¹ËÃ×Íᡌä¢ä´Œ
 ¢Ò´¡ÒþԨÒóÒÈÑ¡ÂÀÒ¾ËÃ×Í¢ŒÍ´Õ¢Í§¼ÙŒÊÙ§ÍÒÂصŒÍ§¡ÒäÇÒÁÃٌ¤ÇÒÁࢌÒã¨ÅѡɳÐ੾ÒТͧ¼ÙŒÊÙ§ÍÒÂØ
«Öè§ÁÕ¤ÇÒÁ«Ñº«ŒÍ¹·Ñ駷ҧ´ŒÒ¹¡Ò¨Ե Êѧ¤Á¨ÔµÇÔ­­Ò³

Comprehensive geriatric assessment

ËÁÒ¶֧ ¡ÒûÃÐàÁÔ¹â´ÂÊËÊÒ¢ÒÇÔªÒªÕ¾·Õ誋ǤŒ¹ËÒ»˜­ËÒ ºÃÃÂÒ ͸ԺÒ»˜­ËÒ·Õè«Ñº«ŒÍ¹áÅ똭ËÒ

ËÅÒÂÍ‹ҧ¢Í§¼ÙŒÊÙ§ÍÒÂØ ÃÇÁ·Ñé§à»š¹¡ÒÃËÒáËŋ§»ÃÐ⪹áÅФÇÒÁࢌÁá¢ç§ (strength) ¢Í§ºØ¤¤Å

¡ÒÃËÒ¢ŒÍÁÙżٌÊÙ§ÍÒÂØᵋÅФ¹áÅйíÒÁÒ㪌à¾×èÍÇҧἹ¡ÒôÙáÅÍ‹ҧ੾ÒÐà¨ÒШ§à»š¹ÃÒ æ ä»

à˵ؼÅ㹡ÒûÃÐàÁÔ¹¼ÙŒÊÙ§ÍÒÂØÍ‹ҧÊÁºÙóáºº

1. ¼ÙŒÊÙ§ÍÒÂØʋǹãË­‹ÁÕ»˜­ËÒÊØ¢ÀÒ¾áÅ똭ËÒÊѧ¤ÁÁÒ¡¡Ç‹Ò˹Ö觻˜­ËÒ

2. ¡ÒûÃÐàÁÔ¹»˜­ËÒ˹Öè§ÁÑ¡¤ÅŒÒ¤ÅÖ§¡Ñ¹ÍÕ¡»˜­ËÒ˹Ö觫Öè§á¡ÍÍ¡¨Ò¡¡Ñ¹ä´ŒÂÒ¡ ઋ¹ ¡ÒÃá¡ÀÒÇÐ

«ÖÁàÈÌҨҡÊÁͧàÊ×èÍÁ ¨Ö§µŒÍ§¡ÒáÒûÃÐàÁÔ¹Ãͺ´ŒÒ¹

3. ÊÒà˵ØËÃ×Í¡Åä¡·Õè·íÒãˌà¡Ô´»˜­ËÒÍÒ¨à¡Ô´¨Ò¡¾ÂÒ¸ÔÊÀÒ¾áÅСÃкǹ¡ÒÃà»ÅÕè¹á»Å§¨Ò¡¤ÇÒÁÊÙ§ÍÒÂØ
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4. »˜­ËÒà´ÔÁÍÒ¨à»ÅÕè¹á»Å§µÒÁ»˜­ËÒËÇÁ ઋ¹ ÀÒÇЫÖÁàÈÌҡѺ¡ÒÃà¡Ô´¤ÇÒÁà¨çº»†Ç·ҧ´ŒÒ¹Ã‹Ò§¡ÒÂ

5. ¡ÒúíҺѴÃÑ¡ÉÒ·ÕèàËÁÒÐÊÁ¨íÒ໚¹¨ÐµŒÍ§ãˌ¤ÇÒÁÊíҤѭ¡Ñº»˜­ËÒ·Õèà¡ÕèÂÇ¢ŒÍ§·Ñé§ËÁ´ áÅеŒÍ§¡ÒáÒÃཇÒ
ÃÐÇѧ áÅеԴµÒÁ»˜­ËÒ·Ñé§ËÁ´ à¾×èͨѴÅíҴѺ¤ÇÒÁÊíҤѭ¢Í§¡ÒÃÃÑ¡ÉÒáÅСÒõѴÊÔ¹ã¨

6. ¡ÒþԨÒóҶ֧¤ÇÒÁ¡ŒÒÇ˹ŒÒ¨ÐµŒÍ§»ÃÐàÁÔ¹»˜­ËÒ·Ñé§ËÅÒÂËÇÁ¡Ñ¹ à¾ÃÒСÒÃÃÑ¡ÉÒ»˜­ËÒ˹Öè§ÍÒ¨´Õ¢Öé¹

ᵋ»˜­ËÒÍ×è¹ÍÒ¨àÅÇŧ

7. ¼Å·ÕèµÒÁÁҢͧ»˜­ËÒ˹Öè§ÍÒ¨¡Ãзºµ‹Í»˜­ËÒÍ×è¹ àª‹¹ àÁ×èÍ¡ÒÃÃٌ¤Ô´àÊ×èÍÁ¶ÍÂŧ·íÒãˌ¤ÇÒÁÊÒÁÒöã¹

¡Ò÷íÒ˹ŒÒ·Õè㹡ԨÇѵûÃШíÒÇѹº¡¾Ã‹Í§

໇ÒËÁÒ¡ÒûÃÐàÁÔ¹ÊíÒËÃѺ¼ÙŒÊÙ§ÍÒÂØ à¾×èÍãˌ䴌¢ŒÍÁÙÅà¡ÕèÂǡѺ

 »˜­ËÒà¡ÕèÂǡѺÊØ¢ÀÒ¾·Ò§¡ÒÂ
 ÊÁÃöÀÒ¾ÊÁͧ
 ÅѡɳзҧÊѧ¤Á
 »ÃÐàÁÔ¹ÊÁÃöÀҾ㹡Ò÷íÒ¡Ô¨Çѵõ‹Ò§ æ
 ÊÀÒ¾âÀª¹Ò¡ÒÃ
 »ÃÐÇѵԡÒÃ㪌ÂÒ

໇ÒËÁÒ¡ÒôÙáżٌÊÙ§ÍÒÂØ

1. à¾×èͤ§¤ÇÒÁÁÕÊØ¢ÀÒ¾´Õ

2. ¤Œ¹¾ºâä (¡ÒÂ/ã¨) ã¹ÃÐÂÐáá ÃÑ¡ÉÒ¶Ù¡µŒÍ§·Ñ¹àÇÅÒ ¿„œ¹¿ÙÊÀҾ͋ҧàËÁÒÐÊÁ

3. ãˌÊÒÁÒö¾Ö觾ҵ¹àͧ䴌ÁÒ¡·ÕèÊØ´ â´ÂÁդسÀÒ¾ªÕÇÔµ·Õè´ÕáÁŒ¨ÐÁÕâäàÃ×éÍÃѧ

4. ãˌ¡ÒôÙáÅÃÐÂÐÊØ´·ŒÒÂà¾×èÍ¡Òèҡä»Í‹ҧÊÁÈÑ¡´ÔìÈÃÕ
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Medicine; Usual VS Geriatric

Usual Medicine Geriatric Medicine

The Ultimate value Biological Life ADL and QOL
Main subjects Diseases Disabilities
Problems to be elucidated Etiology of Disease Risk Factors contributing
Disabilities
Process to discover Medicine Examination Comprehensive Assessment
problems
Principle of treatment Cure Independence in ADL And
increase in QOL

“¨Ø´à¹Œ¹¢Í§¡ÒûÃÐàÁÔ¹¼ÙŒÊÙ§ÍÒÂØáÅСÒôÙáżٌÊÙ§ÍÒÂؤ×ͤÇÒÁÊÒÁÒö㹡Ò÷íÒ˹ŒÒ·ÕèÁÒ¡¡Ç‹ÒÁ؋§à¾Õ§
ÇÔ¹Ô¨©ÑÂáÅÐÃÑ¡ÉÒâä”

PRINCIPLES OF GERIATRIC ASSESSMENT

Goal Promote wellness, independence

Focus Function, performance (gait, balance, transfers)

Scope Physical, cognitive, psychologic, social domains

Approach Multidisciplinary

Efficiency Ability to perform rapid screens to identify target

areas

Success Maintaining or improving quality of life

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ʋǹ»ÃСͺ¢Í§¡ÒûÃÐàÁÔ¹¼ÙŒÊÙ§ÍÒÂØÊÁºÙóáºº

1. ÁÔµÔ´ŒÒ¹¤ÇÒÁÊÒÁÒö㹡Ò÷íÒ§Ò¹(Functional ability) 䴌ᡋ ¡ÒûÃÐàÁÔ¹¤ÇÒÁÊÒÁÒö㹡Ò÷íÒ

¡Ô¨ÇѵûÃШíÒÇѹáÅСÒÃ㪌à¤Ã×èͧÁ×Í㹡ԨÇѵûÃШíÒÇѹ

2. ÁÔµÔ´ŒÒ¹ÊØ¢ÀÒ¾·Ò§Ã‹Ò§¡ÒÂ(Physical health) 䴌ᡋ ¡Òëѡ»ÃÐÇѵԷÕèà¡ÕèÂÇ¢ŒÍ§¡ÑºÊØ¢ÀÒ¾, ¡ÒõÃǨ

Ëҧ¡ÒÂ, ¡ÒÃÁͧàËç¹áÅСÒÃ䴌ÂÔ¹, ¼Å¡ÒõÃǨ·Ò§ËŒÍ§»¯ÔºÑµÔ¡ÒÃ, ·º·Ç¹¡ÒÃ㪌ÂÒ, ¡ÒûÃÐàÁÔ¹ÀÒÇÐ
âÀª¹Ò¡ÒÃ, »ÃÐàÁÔ¹ÊÀÒÇТͧ¿˜¹ áÅСÒûÃÐàÁÔ¹¤ÇÒÁÊÁ´ØÅáÅСÒÃà´Ô¹

3. ÁÔµÔ´ŒÒ¹¡ÒûÃÐàÁÔ¹¡ÒÃÃѺÃٌáÅÐÊØ¢ÀÒ¾·Ò§¨Ôµã¨ 䴌ᡋ ¡ÒûÃÐàÁÔ¹ÊÀÒÇзҧÊÁͧ, ÊÀÒÇТͧ

ÍÒÃÁ³ áÅÐ ÊÀÒÇзҧ¨ÔµÇÔ­­Ò³

4. ÁÔµÔÊÀÒÇзҧÊѧ¤ÁáÅÐÊÔè§áǴŌÍÁ 䴌ᡋ ¡ÒûÃÐàÁÔ¹ ÊÀÒÇзҧÊѧ¤Á, ¡ÒÃà§Ô¹, áÅÐÍѹµÃÒÂã¹

ÊÔè§áǴŌÍÁ

1. »ÃÐÇÑµÔ (¨Ò¡¼ÙŒÊÙ§ÍÒÂØáÅЭҵÔ)

2. »ÃÐàÁÔ¹ functional status

3. Systemic review

4. »˜­ËÒ´ŒÒ¹¨Ôµã¨ – «ÖÁàÈÃŒÒ ãªŒáººÊÑÁÀÒɳÇÔ¹Ô¨©ÑÂâä«ÖÁàÈÌÒ

5. ¡Ò÷´ÊͺÊÁÃöÀÒ¾ÊÁͧ

6. ¡ÒäѴ¡ÃͧẺÊÑé¹
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¡Òëѡ»ÃÐÇѵԼٌ»†ÇÂáÅЭҵÔ

ÍÂً¡Ñºã¤Ã/ã¤Ã໚¹¼ÙŒ´ÙáÅ ¡Òê‹ÇÂàËÅ×Í´ŒÒ¹Í×è¹ æ 㹡ÒôÙáŠઋ¹ ÃѺ-ʋ§ÁÒâç¾ÂÒºÒÅ

ºŒÒ¹à»š¹Í‹ҧäà – ¹Í¹·Õèä˹, µŒÍ§ãªŒºÑ¹ä´äËÁ, ˌͧ¹éíÒÍÂًä˹, ÁÕÃÑéǺŒÒ¹ ?

°Ò¹Ð·Ò§àÈÃÉ°¡Ô¨ – ¤‹Ò㪌¨‹Ò»ÃШíÒÇѹ ¤‹ÒÃÑ¡ÉÒ¾ÂÒºÒÅ

¤ÇÒÁÊÑÁ¾Ñ¹¸ã¹¤Ãͺ¤ÃÑÇ

¡Ô¨¡ÃÃÁ»ÃШíÒÇѹ

¡ÒèѴ¡ÒáԨÇѵûÃШíÒÇѹ Activity of Daily Livings - ADLs

¡ÒûÃÐàÁÔ¹ functional status ¢Í§¼ÙŒ»†ÇÂ

¡ÒûÃÐàÁÔ¹à¡ÕèÂǡѺ¡ÒÃ㪌ªÕÇÔµ»ÃШíÒÇѹ ¡Òê‹ÇÂàËÅ×͵¹àͧã¹áµ‹ÅÐÇѹ

á¹Ç¡Ò÷íÒ systemic review

»ÃÐÁÒ³Ç‹Ò ¡ÒõÃǨËҧ¡Ò´ÙNjÒÁÕ¤ÇÒÁ¼Ô´»¡µÔã´ºŒÒ§ã¹áµ‹ÅÐÃкº

¡Ò÷´ÊͺÊÁÃöÀÒ¾ÊÁͧ

1. ¤ÇÒÁº¡¾Ã‹Í§¢Í§¡ÒÃÃѺÃٌ (Cognitive impairments) ઋ¹»ÃÐàÁÔ¹ÀÒÇÐÊÁͧàÊ×èÍÁ(Dementia

) ¡Å؋ÁÍÒ¡Ò÷ÕèÁÕ¡ÒÃàÊ×èÍÁ¶ÍÂàÃ×éÍÃѧ¢Í§ÊµÔ»˜­­ÒáÅзѡÉÐ㹡ÒÃÃѺÃٌ, µÑ´ÊÔ¹ã¨, ¤ÇÒÁ¨íÒ
2. âä·Õ辺º‹ÍÂÁÒ¡·ÕèÊØ´¢Í§»ÃÐà·È·Ò§µÐÇѹµ¡¤×ÍâäÍÑÅä«àÁÍÏ(Alzheimer’s disease)
ÊÒà˵ØÃͧŧÁÒ¤×Í Vascular dementia, Parkinson’s disease, ÂÒáÅÐÊÒþÔÉ àª‹¹
ÊÁͧ½†Í¨Ò¡áÍÅ¡ÍÎÍŏ, ÀÒÇÐä·ÃÍ´ÎÍÏâÁ¹µèíÒ
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3. à¤Ã×èͧÁ×Í·Õè¹íÒÁÒ·íÒ screening ·Õè㪌º‹Í·ÕèÊØ´¤×Í

- 3 word recall
- word fluency test â´Âãˌ¼ÙŒ»†Çº͡µÑÇÍ‹ҧ ã¹Ë¹Öè§ category ÀÒÂã¹Ë¹Ö觹ҷÕઋ¹ª×èÍÊѵǏ
·Ø¡ª¹Ô´ÀÒÂã¹Ë¹Öè§¹Ò·Õ ¶ŒÒ¹ŒÍÂ¡Ç‹Ò 8-10 ¤íÒ¼Ô´»¡µÔ
- clock drawing test â´Âãˌ¼ÙŒ»†ÇÂÇҴ˹ŒÒ»˜´¹ÒÌÔ¡ÒáÅÐàÇÅÒ·ÕèàÃÒÃкØãˌ¡Ò÷íÒ brief
screeningáŌǶŒÒ¼Ô´»¡µÔ¨Ö§·íÒ full dementia work-up

¡ÒûÃÐàÁÔ¹â´ÂẺ·´Êͺ ã¹»ÃÐà·Èä·Â·Õè¹ÔÂÁÁÕ 2 Ẻ¤×Í

- Ẻ·´ÊͺÊÁÃöÀÒ¾ÊÁͧ¢Í§ä·Â¨Ð·´Êͺ´ŒÒ¹¡ÒÃÃѺÃÙ,Œ ¡Òè´¨íÒ, ¤ÇÒÁãʋã¨, ¡ÒÃ

¤íҹdz, ´ŒÒ¹ÀÒÉÒáÅСÒÃÃÐÅ֡䴌 ¤Ðá¹¹àµçÁ 30 ¤Ðá¹¹¶ŒÒ䴌µèíÒ¡Ç‹Ò 24 ¤Ðá¹¹¼Ô´»¡µÔ
- Ẻ·´Êͺ¨Ôµ¨ØÌÒ(19) ¤Ðá¹¹àµçÁ෋ҡѺ 19 ¤‹Ò¼Ô´»¡µÔ¤×Í䴌¹ŒÍÂ¡Ç‹Ò 15 ¤Ðá¹¹

µÒÃÒ§¡ÒõÃǨÊØ¢ÀÒ¾àº×éͧµŒ¹

¡ÒõÃǨàº×éͧµŒ¹ ¤ÇÒÁ¶Õè (¤ÃÑé§/»‚) ¡Ò䌹ËÒâä

¤ÇÒÁ´Ñ¹âÅËÔµ <1 ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§

µÃǨൌҹÁ 1-2 ÁÐàÃç§àµŒÒ¹Á

µÃǨÀÒÂã¹ 2-3 ÁÐàÃ移ҡÁ´ÅÙ¡

µÃǨÍب¨ÒÃÐ 1 ÁÐàÃç§ÅíÒäʌ

ʋǹÊÙ§/¹éíÒ˹ѡ <1 ͌ǹ/¡Ãд١¾Ãع

¹éíÒµÒÅ 1 àºÒËÇÒ¹

¡Ò÷íÒ§Ò¹¢Í§µ‹ÍÁä·ÃÍ´ 1-2 áÅÐàÁ×èÍÁÕÍÒ¡Òà âää·ÃÍ´

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¡ÒõÃǨÇÑ´ÊÒÂµÒ 1 áÅÐàÁ×èÍÁÕÍÒ¡Òà ¡ÒÃÁͧàË繺¡¾Ã‹Í§

¡ÒõÃǨ¡Òà 1 áÅÐàÁ×èÍÁÕÍÒ¡Òà ¡ÒÃ䴌ÂÔ¹º¡¾Ã‹Í§

䴌ÂÔ¹

µÃǨ¤Å×è¹ä¿¿‡ÒËÑÇ㨠àÁ×èÍÁÕÍÒ¡Òà ËÑÇã¨àµŒ¹¼Ô´»¡µÔ, âäËÑÇã¨

¤ÇÒÁ˹Òṋ¹¢Í§¡Ãд١ 1 ¤ÃÑé§ÊíÒËÃѺ¼ÙŒ·ÕèÁÕ»˜¨¨ÑÂàÊÕè§ âä¡Ãд١¾Ãع

໚¹âä¡Ãд١¾Ãع ઋ¹¼ÙŒË­Ô§

ÊÀÒÇзҧ¨Ôµã¨ 1 «ÖÁàÈÌÒ, ÊÁͧàÊ×èÍÁ

¡ÒõÃǨ¼ÔÇ˹ѧ 1-2 ÁÐàÃ秼ÔÇ˹ѧ

CARE PLAN

1. ÅѡɳмٌÊÙ§ÍÒÂØ : ¼ÙŒÊÙ§ÍÒÂØÊØ¢ÀÒ¾´Õ well elderly

¡ÒôÙáÅ Health maintenance

¡Òä§ÊØ¢ÀÒ¾´Õ

¤ÇÒÁÃÙ,Œ ¤ÇÒÁ¡Ãе×ÍÃ×Í̹,¡ÒÃÁÕʋǹËÇÁ, ¡ÒûÃÐàÁԹ໚¹ÃÐÂеÒÁÍÒÂØáÅСÒôÙáÅ໚¹Í§¤ÃÇÁ

¡Òû‡Í§¡Ñ¹âäáÅзؾ¾ÅÀҾ㹼ٌÊÙ§ÍÒÂØ

ÃкºËÑÇã¨áÅÐËÅÍ´àÅ×Í´

- ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§
- ä¢Áѹã¹àÅ×Í´ÊÙ§
- âäËÑÇã¨
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Ãкº»ÃÐÊÒ·

- ÊÁͧàÊ×èÍÁ
- ÍÑÁ¾Òµ

»‡Í§¡Ñ¹âäáÅзؾ¾ÅÀҾ㹼ٌÊÙ§ÍÒÂØ

- ¡Ãд١¾Ãع
- á¼Å¡´·Ñº
- ¢ŒÍÂÖ´µÔ´
- âäµÔ´àª×éÍ  ÇѤ«Õ¹

¡ÒÃãˌÀÙÁԤ،Á¡Ñ¹¼ÙŒÊÙ§ÍÒÂØ

- ÇѤ«Õ¹ä¢ŒËÇÑ´ãË­‹
- ÇѤ«Õ¹¹ÔÇâÁ¤Í¤¤ÑÊ
- ÇѤ«Õ¹ºÒ´·ÐÂÑ¡

¡Ò䌹¾ºâäã¹ÃÐÂеŒ¹áÅСÒÃÃÑ¡ÉÒ

ÁÐàÃç§

• ൌҹÁ

• »Ò¡Á´ÅÙ¡ / Á´ÅÙ¡/Ãѧ䢋

• ÅíÒäʌãË­‹

• µ‹ÍÁÅÙ¡ËÁÒ¡

2. ÅѡɳмٌÊÙ§ÍÒÂØ ÁÕâäàÃ×éÍÃѧáÅÐ/ËÃ×ÍÀÒÇзؾ¾ÅÀÒ¾ ¡ÒôÙáÅ Disease controlled

3. ÅѡɳмٌÊÙ§ÍÒÂØ Ë§‹ÍÁ/§ÍÁ/ºÍººÒ§/ frail elderly ¡ÒôÙáÅ Symptoms controlled
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ÊÔ觷Õè¤ÇäíÒ¹Ö§¶Ö§

1.¨Ø´Á؋§ËÁÒ¢ͧ¡ÒôÙáÅ ¤×Í ¡Òä§ÈÑ¡ÂÀÒ¾änjãˌ䴌ÊÙ§ÊشËÇÁ¡Ñº¡ÒÃÁդسÀÒ¾ªÕÇÔµ·Õè´Õ

2. ¶Ö§¨ÐÊÙ§ÍÒÂØ ª‹ÇÂàËÅ×͵¹àͧ䴌Ŵŧ ᵋÂѧµŒÍ§¡ÒáÒÃÂÍÁÃѺ¹Ñº¶×Í ÁÕÊÔ·¸ÔìáÅÐàÊÃÕÀÒ¾¢Í§µ¹àͧ

3. ¼ÙŒÊÙ§ÍÒÂØᵋÅФ¹áµ¡µ‹Ò§¡Ñ¹ä»¢Ö鹡ѺÀÙÁÔËÅѧáÅкؤÅÔ¡ÀÒ¾

4. ¢ÍãˌàÇÅÒã¹áµ‹ÅÐÇѹ໚¹ä»Í‹ҧÁÕ¤ÇÒÁËÁÒ Áդس¤‹ÒáÅÐà¾ÔèÁ¾Ù¹ÈÑ¡ÂÀÒ¾

5. ÊÌҧ¤ÇÒÁÃٌÊ֡NjҼٌÊÙ§ÍÒÂØÂѧÁÕ¤ÇÒÁÊíҤѭáÅÐÊÒÁÒö´Ùáŵ¹àͧ䴌
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Part II ¡®ËÁÒ¡ÒÃᾷ
º··Õè 7: ÈÒÅáÅСÃкǹ¡ÒÃÂصԸÃÃÁ
º··Õè 8 : ¡®ËÁÒ·Õèà¡ÕèÂÇ¢ŒÍ§¡Ñº¡ÒûÃСͺÇÔªÒªÕ¾áÅÐÊÔ·¸Ô¼ÙŒ»†ÇÂ

(-)

Part III ËÅѡʶԵ , ¡ÒÃÇԨѷҧ¡ÒÃᾷ áÅÐ ¡ÒÃ

»ÃÐÂØ¡µãªŒ·Ò§¡ÒÃᾷ
º··Õè 9 : Quantitative Methods (-)
º··Õè 10 : ¨ÃÔ¸ÃÃÁ㹡Ò÷´ÅͧáÅСÒÃÇԨѷҧ¡ÒÃᾷ
¨ÃÔ¸ÃÃÁ¡Ò÷íÒÇÔ¨ÑÂ㹤¹

ËÅѧʧ¤ÃÒÁâÅ¡¤ÃÑ駷Õè 2 ¢ŒÍÊíҤѭ¤×Í ¡Ò÷´Åͧ㴠æ ã¹Á¹Øɏ¨Ð¡ÃзíÒ䴌¡çµ‹ÍàÁ×èÍ䴌ÃѺ¤ÇÒÁÂÔ¹ÂÍÁ

â´ÂÊÁѤÃ㨨ҡ¼ÙŒ¶Ù¡·´Åͧ

·Õè»ÃЪØÁÊÁѪªÒãË­‹¢Í§Í§¤¡ÒÃÊË»ÃЪҪҵÔ

“Á¹Øɏ¨Ð¶Ù¡¡ÃзíÒËÃ×Íŧâ·Éâ´Â¡Ò÷ÃÁÒ¹ ËÃ×Í¡ÃзíÒ·Õè·ÒÃسâ˴ÌÒÂäÌÁ¹ØɸÃÃÁ ÁÔ䴌 â´Â੾ÒÐ

Í‹ҧÂÔ觨йíÒÁ¹Øɏ价íÒ¡Ò÷´Åͧ·Ò§¡ÒÃᾷËÃ×Í·Ò§ÇÔ·ÂÒÈÒʵÏ â´Â»ÃÒȨҡ¡ÒÃÂÔ¹ÂÍÁâ´ÂÍÔÊÃÐ
ÁÔ䴌”
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ÊÀÒͧ¤¡ÒÃÊÒ¡Å´ŒÒ¹ÇÔ·ÂÒÈÒʵÏ¡ÒÃᾷ (Council for International Organizations of

Medicine Sciences: CIOMS) áÅÐͧ¤¡ÒÃ͹ÒÁÑÂâÅ¡ 䴌¨Ñ´·íÒ

“á¹Ç·Ò§ÊÒ¡ÅÊíÒËÃѺ¡ÒÃÈÖ¡ÉÒÇԨѷҧÇÔ·ÂÒÈÒʵÏ¡ÒÃᾷà¡ÕèÂǡѺ¡Ò÷´Åͧã¹Á¹Øɏ”

¤ÇÒÁËÁÒ¨ÃÔ¸ÃÃÁ¡Ò÷íÒÇÔ¨ÑÂ㹤¹
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Alternative Medicine

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2. ¡Òû¯ÔºÑµÔµÒÁ¤ÇÒÁàª×èÍ·Õèà¡ÕèÂÇ¢ŒÍ§¡ÑºÊØ¢ÀÒ¾«Öè§áµ¡µ‹Ò§ä»¨Ò¡Áҵðҹ¡ÒÃᾷ¡ÃÐáÊËÅÑ¡

ẋ§à»š¹ 6 ¡Å؋Á¤×Í

1. Traditional ઋ¹ ¡ÒùǴ ¡ÒûÃФºÊÁعä¾Ã 㪌à¾×èÍʋ§àÊÃÔÁáÅÐÃÑ¡ÉÒÊØ¢ÀÒ¾

a. â¤РʹÍÒËÒÃŌҧ¾ÔÉ  india
b. ¡Òý˜§à¢çÁ ¡ÒùǴ½†Òà·ŒÒ  China
2. Bioelectromagretic ÊÌҧ¤ÇÒÁÊÁ´ØŢͧ¡ÃÐáÊáÁ‹àËÅç¡ä¿¿‡ÒªÕÇÀÒ¾ã¹Ã‹Ò§¡Ò ¹ÔÂÁ㪌ã¹
¡ÒÃÃÑ¡ÉÒ¾ÂÒºÒżٌ»†ÇÂ
3. Structural & Energetic therapy à·¤¹Ô¤ºíҺѴ
a. Chiropractic = ÇÒÃÕºíҺѴ¤×Í ¡ÒÃÍÍ¡¡íÒÅѧ¡Ò¹éíÒ
b. ¹ÔÂÁ㪌㹡ÒÃÃÑ¡ÉÒáÅп„œ¹¿ÙÊØ¢ÀÒ¾¢Í§¼ÙŒ»†ÇÂ
4. Diet /Nutrition/Life-style
a. ์¹»ÃѺà»ÅÕ蹡ÒúÃÔâÀ¤ÍÒËÒà ÍÒËÒÃÊØ¢ÀÒ¾ ¹éíҼѡ-¼ÅäÁŒ ¡ÒÃÊǹŌҧÅíÒäʌ áÅÐ
ÍÒËÒÃÁѧÊÇÔÃѵÔ
b. ʋ§àÊÃÔÁ,ÃÑ¡ÉÒáÅп„œ¹¿ÙÊØ¢ÀÒ¾
5. Body/Mind control ÊÁÒ¸ÔºíҺѴ ´¹µÃÕºíҺѴ Aromatherapy
a. Bio treatment 㪌ÊÒêÕÇÀÒ¾ ÊÒèҡ¸ÃÃÁªÒµÔ-ÊÁعä¾Ã ¹éíÒ»˜ÊÊÒÇкíҺѴ
b. 㪌ʋ§àÊÃÔÁ,ÃÑ¡ÉÒáÅп„œ¹¿ÙÊØ¢ÀÒ¾
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 54

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ËÅѡ㹡ÒÃàÅ×͡㪌¡ÒÃᾷ·Ò§àÅ×͡㹡ÒôÙáÅÊØ¢ÀÒ¾

1. ÈÖ¡ÉÒNjÒ໚¹ÈÒʵÏ·ÕèÁÕÃÒ¡à˧ŒÒÁÒ¨Ò¡Í´ÕµËÃ×ÍäÁ‹
2. ¾Í¨ÐÁÕËÅÑ¡°Ò¹¡ÒÃÇÔ¨ÑÂʹѺʹع·Õèàª×èͶ×Í䴌ËÃ×ÍäÁ‹
3. ¹íÒÁÒ㪌áŌÇÊÒÁÒö¾Ö觵¹àͧ䴌 ·Ñ駵¹àͧ ¤Ãͺ¤ÃÑÇ ªØÁª¹áÅлÃÐà·ÈËÃ×ÍäÁ‹
4. µŒ¹·Ø¹¡ÒÃãˌºÃÔ¡ÒÃàËÁÒÐÊÁ-¤ØŒÁ¤‹Ò

µÑÇÍ‹ҧ·Õè¹ÔÂÁ㪌

1. Constipation 㪌 ´ØÁàËç´à·È ¢ÕéàËÅç¡ ÁТÒÁᢡ ÁТ‹ÒÁ

2. ᡌÍÒ¡Ò÷ŒÍ§Í×´ ṋ¹¿‡Í ¨Ø¡àÊÕ´ ´Õ»ÅÕ µÐä¤ÃŒ ¢ÁÔ鹢ѹ(ÁÕÊÒáÃе،¹¹éíÒ´Õ)
3. ᡌÍÒËÒ÷ŒÍ§à´Ô¹ 㺽ÃÑè§ ¿‡Ò·ÐÅÒÂâ¨Ã Áѧ¤Ø´
4. ÊÁعä¾Ã¶‹Ò¾ÂÒ¸ÔÅíÒäʌ ÁÐà¡Å×Í(ÍÒ¨·íÒãˌµÒºÍ´)¿˜§·Í§ ÁТÒÁ ÊÐá¡ àÅçºÁ×͹ҧ
5. ᡌäÍ ¢ÑºàÊÁËÐ ¢Ô§ ´Õ»ÅÕ ÁÐánj§à¤Ã×Í(¢Á+steroid) ÁйÒÇ
6. ᡌäÍ ãªŒ¿‡Ò·ÐÅÒÂâ¨Ã ºÍÃÐà¾ç´ »ÅÒäËÅà¼×Í¡ ‹ҹҧ µÃÖ§ºÒ´ÒÅ(ÃÑ¡ÉÒ malaria)
7. ᡌ¼×è¹ ¤Ñ¹ 㪌¢ÁÔ鹪ѹ ¾ÅÙ
8. ᡌ»˜ÊÊÒÇР㪌˭ŒÒ˹ǴáÁÇ (¼ÙŒ»†ÇÂâäËÑÇ㨠ˌÒÁ¡Ô¹) ¡ÃÐà¨Õêºᴧ(»‡Í§¡Ñ¹ BPH) Ë­ŒÒ¤Ò
9. ÃÑ¡ÉÒ¡ÃÐà¾ÒÐÍÒËÒà 㪌¢ÁÔ鹪ѹ
10. ÃÑ¡ÉÒä¿äËÁŒ ¹éíÒÌ͹ÅÇ¡ 㪌ºÑǺ¡ NjҹËÒ§¨ÃÐࢌ
11. ÃÑ¡ÉÒà¤Å索ѴÂÍ¡ 㪌 ä¾Å

¼Ñ¡¾×鹺ŒÒ¹ ãºÂÍ µíÒÅÖ§ ´Í¡á¤ ªÐ¾Å٠ᵧ¡ÇÒ áÁ§ÅÑ¡ ÁÐà¢×;ͧ ¾ÃÔ¡ä·Â ¡ÃЪÒ ºÇº ¡Ôè§
¾ÅÙ ¡ÃÐà·ÕÂÁ ÁТÒÁ

¼Ñ¡¨ÔéÁ-ÍÕÊÒ¹ ‹ҹҧ ÁС͡ ¼Ñ¡ËÇÒ¹ ˹‹ÍäÁŒ ¼Ñ¡¢Á

ÀҤ㵌 ÊÐµÍ ÅÙ¡à¹Õ§ ÅÙ¡©Ôè§ ÂÍ¡¨Ô¡ ÅÙ¡àËÃÕ§ ÂÍÁÁÐÁ‹Ç§ËÔÁ¾Ò¹µ ºÑ¡º¡ ÂÍ´ÁлÃÒ§

·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 55

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Part IV »˜­ËÒ¨ÃÔ¸ÃÃÁà¡ÕèÂǡѺ¤ÇÒÁµÒÂ
º··Õè 12 : »˜­ËÒ¨ÃÔ¸ÃÃÁà¡ÕèÂǡѺ¤ÇÒÁµÒÂáÅÐÀÒÇÐã¡ÅŒµÒÂ

- Death and dying(¤ÇÒÁµÒÂáÅÐÀÒÇÐã¡ÅŒµÒÂ) = end of life care

- »ÃÐà´ç¹¨ÃÔ¸ÃÃÁ(Ethical tissue)áÅÐàǪ¨ÃÔÂÈÒʵÏ(medical ethics)
- Á¹Øɏ¾Ö§µÒÂÍ‹ҧʧºÊÁÈÑ¡´ÔìÈÃÕ
- Paradigm shift = ¡ÒûÃѺ¡Ãкǹ¡Ò÷Ñȹ ¤ÇÃÁͧNjҼٌ»†ÇÂã¡ÅŒµÒÂ໚¹ÊÔ觷ÕèÁդس¤‹Ò໚¹
¤ÇÒÁ´Õ§ÒÁ
- Good life  good health  Good death
- àÁ×èÍ¡ÒÃÃÑ¡ÉÒ¾ÂÒºÒÅäÁ‹ºÃÃÅؼŠ¨Ð¾ÂÒÂÒÁºÃÃà·Ò·Ø¡¢·ÃÁÒ¹µÒÁÍÒ¡ÒÃáÅШФíҹ֧NjҡÒõÒÂ
Í‹ҧʧºÊØ¢¢Í§Á¹Øɏ໚¹Ê໇ÒËÁÒ·ÕèÊíҤѭ¢Í§ªÕÇÔµÁ¹Øɏ
- Á¹Øɏ¾Ö§µÒÂÍ‹ҧʧº = Euthanasia (well death , beautiful death , good death) ,
Eu=well , thanasia = death
- Death and dying ã¹ÈÒʵϵ‹Ò§æ
o Scientific perspective  µÒ = ¡ŒÒ¹ÊÁͧµÒÂ
o Religious perspective  ÁØÊÅÔÁ ¡ÒõÒ¤×Í¡ÒÃ䴌ä»à½‡Ò¾ÃÐÍÑÅàÅÒˏ
o Philosophical perspective  »ÃѪ­Ò ¡ÒõÒ = fact
o Legal perspective (·Ò§¡®ËÁÒÂ)
- ¡ÒôÙáżٌ»†ÇÂÃÐÂзŒÒ (end of life care)
o Hospice care = (Hospice ·Õè¾Ñ¡ÃÐËNjҧ·Ò§¢Í§¤¹ã¡ÅŒµÒÂ)
o Palliative care = ¡ÒôÙáÅẺͧ¤ÃÇÁ ´ÙáÅẺ»ÃФѺ»ÃФͧ
o supportive care =
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 56

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o holistic care = ¤ÇÒÁࢌÒã¨Á¹Øɏâ´Âͧ¤ÃÇÁ áÅÐà¤Òþ㹤ÇÒÁ໚¹µÑÇàͧ¢Í§

¼ÙŒ»†Ç (autonomy)
- ËÅÑ¡¡ÒôÙáżٌ»†ÇÂ
o Comfort = Å´¤ÇÒÁ·Ø¡¢
o Dignity (ÈÑÈÑ¡´ÔìÈÃÕ)
o Quality
uality of life (¤Ø( ³ÀÒ¾ªÕÇÔµ)

Stage in disease Goal of therapy Conceptual Orientation of

process framework for care treatment
program
Diagnosis Cure Hospital base Disease
Process Control
Terminal Palliate (pallicum = Hospice Autonomy holistic
cloak àÊ×éͤÅØÁ)

Holistic health care

physical
ความรูสึกที่ละเอียดออนที่
มนุษยแตละคนมีสิ่งที่ทํา
ใหมีพลัง ไทยใช spiritual
social spiritual
วา ปญญา แตในการปฏิบัติ
wellness แลว spiritual คือสิ่งที่ๆ
คนๆหนึงยึดเหนี่ยวไว ได
พบ(บางคนอาจจะแม ) ได
เห็น (อาจเปนสิ่งของ) แลว
emotional intelecture
รูสึกดีขึ้น เปนตน
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 57

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Palliative care

1. Doing things for the patient

2. Psychological well being
3. Comprehensive information
4. Maintaince quality of life
5. Integrate family into care
6. Respect patient’s wish
7. Effective symptom relief
8. Include patient in decision making
9. Make time as pleasant as possible
10. Providing the opportunity to say goodbye

Ethical tissue 㹡ÒôÙáżٌ»†ÇÂÇÒÃÐÊØ´·ŒÒÂ

1. ¡Òú͡¢ŒÍÁÙÅ ¡Òþٴ¤Ø¡Ѻ¼ÙŒ»†Ç (veracity)

2. ¡Òú͡¤ÇÒÁ¨ÃÔ§(truth-telling)
3. ¡ÒúÃÃà·Ò¤ÇÒÁ·Ø¡¢·ÃÁÒ¹
4. ¡ÒõѴÊÔ¹ã¨àÁ×èÍ༪ԭ dilemma
5. ¡Òõͺʹͧ·Ò§¨ÔµÇÔ­­Ò³(spiritual healing)
6. ã¤Ã¤×ͼٌµÑ´ÊÔ¹ã¨(reason , accountable)

¡ÒõÒÂÍ‹ҧʧº

1. Active euthanasia ·íÒãˌµÒÂâ´ÂµÃ§ ¼ÙŒ»†ÇÂäÁ‹ÃٌÊÖ¡µÑÇ

·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 58

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2. Passive euthanasia ÂÍÁÃѺ¤ÇÒÁµÒ ÂصԡÒÃÃÑ¡ÉÒ·Õè໚¹·Ø¡¢àÇ·¹Ò»˜¨¨ØºÑ¹ã¹àÁ×ͧä·ÂÁÕ

¾Ãº.ÃѺÃͧ â´Â¨Ð´ÙáÅÃÑ¡ÉÒµÒÁÍÒ¡ÒÃá·¹áÅдÙáÅ´ŒÒ¹¨ÔµÇÔ­­Ò³

Basic knowledge of psychology of death and dying

Death ËÁÒ¶֧ ¼ÙŒ·ÕèàÊÕ vital functions áŌÇ

Dying ËÁÒ¶֧ ¼ÙŒ·ÕèÍÂً㹢Ñ鹵͹«Ö觡íÒÅѧ¨ÐÊÙ­àÊÕ vital functions ä»

Reactions to Death

ẋ§à»š¹¤ÇÒÁµÒÂàÁ×èÍàÇÅÒÍѹ¤Çà áÅС‹Í¹àÇÅÒÍѹ¤ÇÃ

¤¹·Õè¶Ö§àÇÅÒÍѹ¤ÇÃÁÑ¡¨ÐäÁ‹µ×è¹µÃÐ˹¡ËÃ×ÍàÊÕÂã¨Áҡ෋ҤÇÒÁµÒ¡‹Í¹àÇÅÒÍѹ¤Çà ઋ¹ ¤¹ÍÒÂØ

¹ŒÍ ¡ÒõÒ¨ҡÀÑÂ¾ÔºÑµÔ ÍغѵÔà赯 ËÃ×ÍàÃ×èͧ·ÕèäÁ‹¤ÇõÒÂ

¤ÇÒÁµÒÂÁÕ¤ÇÒÁËÁÒÂã¹·Ò§¨Ôµã¨ ઋ¹ ¤ÇÒÁµÒ¤×Í¡ÒÃÊÔé¹ÊØ´¢Í§âäÀÑ ¤ÇÒÁµÒ¤×Í¡ÒÃŧâ·É·Õè

㪌ªÕÇԵ͋ҧ¼Ô´ºÒ»ÁÒµÅÍ´

Psychogenic Death

»˜¨¨Ñ·ҧ¨Ôµã¨¡çÁÕ¼ÅãˌµÒÂ䴌 ઋ¹ ¤¹·ÕèÁÕ ventricular fibrillation áÅÐ MI ÍÒ¨µÒ¨ҡ

psychic stress 䴌

ÁÕ¤¹àª×èÍÇ‹Ò hypothalamic-pituitary adrenal axis áÅÐ ANS à¡Ô´ dysfunction 䴌¨Ò¡

emotional stress ໚¹à˵Øãˌ vital function ËÂØ´·íÒ§Ò¹

Impending Death

Elisabeth Kuber-Ross 䴌ÊÃØ»»¯Ô¡ÔÃÔÂҢͧ¼ÙŒ·Õèã¡ÅŒ¨ÐµÒÂänj´Ñ§¹Õé

·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 59

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1 - Shock and denial

2 - Anger

3 - Bargain

4 - Depression

5 - Acceptance

Attitude toward death across the life cycle

1. à´ç¡µèíÒ¡Ç‹Ò 5 ¢Çº«Öè§ÁÕ animistic àª×èÍNjÒÊÔ觢ͧäÁ‹ÁÕªÕÇÔµ¡çÁÕªÕÇÔµ ´Ñ§¹Ñ鹨֧¤Ô´Ç‹Ò¤ÇÒÁµÒÂ໚¹

à¾Õ§¡Òù͹ËÅѺ

2. à´ç¡ 5-10 »‚ àÃÔèÁÁÕ concrete operation ¨Ð¾Ñ²¹Ò¤ÇÒÁÃٌÊ֡NjÒÁ¹ØɏËÒÂ仨ҡâÅ¡

à¾ÃÒФÇÒÁµÒ áÅСÅÑÇ·Õ辋ÍáÁ‹¨ÐµÒ«Ö觵¹àͧ¨Ð¶Ù¡·Í´·Ôé§ à´ç¡ 9-10 »‚¨ÐàÃÔèÁÃٌNjҤÇÒÁ
µÒÂà¡Ô´¢Öé¹ä´Œ·Ñ駡Ѻµ¹àͧáÅо‹ÍáÁ‹

3. ÇÑ¡‹Í¹ÇѹÃ؋¹ àÃÔèÁÃٌNjҤÇÒÁµÒÂ໚¹ÊÔ觷Õè·Ø¡¤¹µŒÍ§»ÃÐʺ äÁ‹Ëǹ¡ÅѺ ˹ÕäÁ‹¾Œ¹ àËÁ×͹·Õè

¼ÙŒãË­‹à¢ŒÒã¨

4. ÇÑÂÃ؋¹

a. ÃٌNjҤÇÒÁµÒÂ˹ÕäÁ‹¾Œ¹áÅÐ໚¹¨Ø´ÊÔé¹ÊØ´ ÊÔ觷Õ褹ÇѹÕé¡ÅÑǤ×Í ÊÔ觷Õè¤Çº¤ØÁäÁ‹ä´Œ,

¤ÇÒÁäÁ‹ÊÁºÙóáºº, ᵡµ‹Ò§¨Ò¡¤¹Í×è¹ ´Ñ§¹Ñ鹶ŒÒà¨çº»†ÇÂËÃ×͵ŒÍ§àÊÕªÕÇÔµ¡çµŒÍ§ÍÂً
º¹¾×é¹°Ò¹¢Í§¡ÒÃËÅÕ¡àÅÕ觤ÇÒÁ¡ÅÑÇàËŋҹÕé

b. ÇѹÕéÁÕÊÔ·¸Ô㹡ÒõѴÊÔ¹ã¨ã¹¡ÒÃ༪ԭ˹ŒÒ¡Ñº¤ÇÒÁµÒ¢ͧµ¹Í‹ҧÁÕÈÑ¡´ÔìÈÃÕáŌÇ

5. ÇѼٌãË­‹
·Ñ¡Éо×é¹°Ò¹ÇÔªÒªÕ¾áÅÐàǪ¨ÃÔÂÈÒʵÏ àŋÁ 2 P a g e | 60

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a. ÂÍÁÃѺNjÒàÇÅÒ¹Ñé¹ã¡ÅŒ¨ÐÁÒ¶Ö§áŌÇ

b. ÍÒ¨¾Ù´¶Ö§¤ÇÒÁµÒÂ䴌Í‹ҧʹءʹҹ ÂÔ¹´ÕÃѺ䴌

c. àÁ×èÍࢌÒÊًÇѪÃÒ ¨ÐàÃÔèÁÃÐÅÖ¡¶Ö§àÇÅÒ·ÕèàËÅ×Í áÅФԴ䴌NjҤÇèÐÁÕªÕÇÔµÍÂًµ‹Íä»Í‹ҧäÃ

¤¹·Õè»ÃѺµÑÇ䴌¨ÐÁͧªÕÇԵŒ͹ä»Í‹ҧÀÒ¤ÀÙÁÔ㨠¤Ô´Ç‹Ò䴌㪌ªÕÇԵ͋ҧÁդس¤‹ÒáÅŒÇ äÁ‹
¡ÅÑǤÇÒÁµÒÂ

d. ¤¹·Õè»ÃѺµÑÇäÁ‹ä´Œ¨ÐàÊÕ´ÒÂàÇÅÒ ¡ÅÑÇ àË§Ò ÊÔé¹ËÇѧ

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Part V ÀÒ¤¼¹Ç¡
µÑÇÍ‹ҧ Case studies ·Ò§¡ÒÃᾷ

4th principle of medicine ethics

1. Respect for autonomy à¤Òþ㹤ÇÒÁ໚¹Á¹Øɏ¢Í§¼ÙŒ»†Ç à¤Òþ㹡ÒõѴÊԹ㨢ͧ

¼ÙŒ»†ÇÂ
2. Beneficence ÂÖ´»ÃÐ⪹¢Í§¼ÙŒ»†ÇÂ໚¹ËÅÑ¡
3. Non-malficence = do no harm
4. Justice ÁÕ¤ÇÒÁÂصԸÃÃÁ㹡ÒÃÃÑ¡ÉҼٌ»†ÇÂ

ÊíÒËÃѺËÅѡ㹡Òõͺ¤íÒ¶ÒÁNjҤÇèÐÃÑ¡ÉҼٌ»†ÇÂÍ‹ҧäÃ

â´ÂʋǹµÑÇáŌǤԴNjÒËÅÑ¡·Õ赌ͧÁÕ¤×Í

1. µŒÍ§Ãٌ¡‹Í¹Ç‹Ò ÍÒ¡Ò÷Õè¼ÙŒ»†ÇÂ໚¹ÍÂً¹Ñé¹ ÃعáçÁÒ¡¹ŒÍÂᤋä˹ ÍѹµÃÒ¢¹Ò´ä˹

a. ¶ŒÒÍѵÃÒÂÁÒ¡¶Ö§¤ÇÒÁµÒ ¡çŧÁ×ÍÃÑ¡ÉÒàÅ äÁ‹µŒÍ§ÃÍÁÒà«ç¹µÂÔ¹ÂÍÁ¡Ñ¹ËÃÍ¡ äÁ‹µŒÍ§¡ÅÑÇ
NjҨÐâ´¹¿‡Í§ »Å. µŒÍ§ÃÑ¡ÉÒµÒÁÁҵðҹ¢Í§á¾·Â·Ø¡Í‹ҧ¹Ð äÁ‹ãª‹Ç‹Ò ÃÕºÃÑ¡ÉÒᵋÁÑèÇ
Íѹ¹Õé͋мԴ¹Ð ¼Ô´µÃ§ÃÑ¡ÉÒÁÑèÇæ äÁ‹¶Ù¡µÒÁËÅÑ¡ËÃ×ÍÁҵðҹ¢Í§á¾·Â
i. ¶ŒÒ¾‹ÍáÁ‹ËÃ×ͼٌ·ÕèÁÕÊÔ·¸ÔìµÑ´ã¨äÁ‹ÂÍÁ ¨Ð·íÒä§ Í‹ҧ·ÕèºÍ¡¶ŒÒÃعáçÁÒ¡ à´ÕèÂÇ
¼ÙŒ»†ÇµÒ¡çÃÑ¡ÉÒä»à¶ÍÐ ¡®ËÁÒÂÁÕ¢ŒÍ¡ànj¹ ÁÕ ¾Ãº.ÃѺÃͧ
b. ¶ŒÒäÁ‹ÍѹµÃÒÂÁÒ¡ ÃÍ䴌 ¡çÃÑ¡ÉÒµÒÁÍÒ¡ÒÃ仡‹Í¹ ᵋ¤ÇÃÃͺ¤Íº´ŒÇ ¾ÂÒÂÒÁ¤Ø¡Ѻ¼ÙŒ
·ÕèÁÕÊÔ·¸ÔìµÑ´ÊÔ¹ã¨Ç‹Ò¨ÐÃÑ¡ÉÒÍ‹ҧäà ¶ŒÒऌÒ͹حҵ ¡çŧÁ×Í䴌 ᵋ¶ŒÒऌÒäÁ‹ÂÔ¹ÂÍÁ¡çˌÒÁ
à´ç´¢Ò´ ÃÑ¡ÉÒµÒÁÍÒ¡ÒÃ仡‹Í¹
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2. ¤ÇÒÁÅѺ¼ÙŒ»†ÇÂ
a. ˌÒÁà´ç´¢Ò´¶ŒÒ¼ÙŒ»†ÇÂäÁ‹Í¹Ø­Òµ áͺ仺͡¤¹Í×è¹äÁ‹ä´Œ ¡ÃЫԺ¡çäÁ‹ä´Œ ºÍ¡ÍŒÍÁæ¡ç
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