照顧一位遭受婚姻暴力創傷後壓力疾患之護理經驗

Nursing a Patient with Post-traumatic Stress DisorderCaused by Marital Violence

李绣惠(Hsiu-Hui Lee) ； 李玉蘭(Yu- lan Lee) ； 周桂如(Kuei-Ru Chou)

《精神衛生護理雜誌》 6卷1期 (2011/06) Pp. 28-36

https://doi.org/10.6847/TJPMHN.201106_6(1).0004

摘要

本文描述一位經歷婚姻暴力創傷後壓力疾患之護理經驗，護理期間為2007年12月1日至2007年12月30日。筆者運用觀察、會談及整體性護理評估等方式收集資料，發現個案有高危險性暴力行為－朝向自己、恐懼、睡眠障礙等護理問題。與個案建立信任的治療性人際關係，每天與個案會談30分，並鼓勵說出內心之焦慮、想死之計劃與想法，與個案訂定契約，不得採取自傷行為且須立即尋求醫謢人員之協助；並運用認知治療理論，引導個案將自動化思考進行駁斥、指導練習書寫「不良功能認知記錄」之記錄方式，採傾聽、接納、同理的態度，協助察覺自己負向想法，協助矯正扭曲的認知；在睡眠部分鼓勵個案參與每日的職能活動，並於黃昏時加強戶外活動時間增加日照。在措施執行後，個案已能口頭來表達內心之感受及有效的因應模式面對情緒反應。翼望此護理經驗，能提供醫護同仁面對類似個案之參考，提升護理照護之品質。

關鍵字

婚姻暴力 ； 創傷後壓力疾患 ； 認知行為治療

並列摘要

This article describes the nursing of a patient with post-traumatic stress disorder brought about by marital violence. The nursing period was from December 1st to December 30th, 2007. The author collected data using observation, interview, and holistic nursing assessment and found that the patient engaged inhigh-risk, violent behaviors towards herself, and suffered from fear, sleep disorders, and other nursing problems. A trusting therapeutic relationship with the subject was established, and a half-hour interview was conducted daily with the patient, encouraging her to express her inner anxiety, suicidal plans, andassociated thoughts. A contract was agreed whereby the patient was to perform no self-harm but seek immediate help if necessary from healthcare personnel. Cognitive therapy was adopted by practicing keeping ”dysfunctional cognition records” to guide the patient to refute her automatic thoughts. Listening, accepting, and empathizing attitudes were used to help her perceive her negative thoughts and correcther distorted cognition. With respect to sleep, the patient was urged to take part in daily occupational activities, with an extended length of time spent on outdoor activities at dusk for additional exposure to the sun. After these strategies had been carried out, the patient was able verbally to express her innerfeelings and adopt effective coping models to face her emotional reactions. It is hoped that this nursing experience can serve as a reference for medical staff faced with a need to improve the quality of the nursing experience.

並列關鍵字

marital violence ； post-traumatic stress disorder ； cognitive behavioral therapy