應用行為治療於一位注意力不足過動症個案之護理經驗

A Nursing Experience of Behavior Therapy with an Attention-deficit/ Hyperactivity Disorder Patient

陳侑浩(Yu-hao Chen) ； 陸瑞玲(Ray-Ling Luh)

《精神衛生護理雜誌》 6卷1期 (2011/06) Pp. 56-65

https://doi.org/10.6847/TJPMHN.201106_6(1).0007

摘要

本文係筆者針對一位注意力不足過動症（ADHD），因衝動控制力不佳及情緒調適障礙，而出現暴力行為之青少女的護理經驗。於2008年4月4日至5月2日護理期間，運用「精神衛生護理評估」並藉由會談、觀察等方式收集資料，發現個案有高危險性暴力、因應能力失調、照顧者角色緊張等健康問題。經建立治療性人際關係，協助個案確認其干擾、暴力等非理性因應行為，及負向情緒表達所導致之人際困擾與親子衝突等問題，藉由行為治療之各項操作技巧，有效改善個案問題行為，增加其生活自理及自我控制能力，進而提升自信與自尊。本報告闡述護理人員在照顧青少女ADHD個案時，除了監測藥物效果外，藉由行為治療可有效改善個案干擾、衝動行為，並學習正向情緒調適之技巧。案母共同參與行為治療計畫期間，護理人員同理單親案母，需獨自面對案女初次被診斷為ADHD的衝擊與情緒衝突，提供情緒支持與疾病相關護理，及教導調整親子互動技巧、教養方式，提升個案及案母於出院後發展正向親子互動關係，及學習正確疾病處置能力，使個案與案母共同建構規律、結構化的生活型態，達到與疾病共存的生活適應能力。

關鍵字

行為治療 ； 注意力不足過動症

並列摘要

This article describes our experience of nursing an adolescent girl with ADHD and prone to violent acts due to poor impulse control and emotional adjustment disorder. In the nursing process, information was collected through the interview and observation methods. By means of a psychiatric mental health nursing assessment, we found that the patient’s health problems included a high risk of violence, and a lack of adaptation and problem-solving ability. During the establishment of therapeutic relationships with the patient and her mother, we strengthened the patient’s motivation to change by helping her to affirm her non-rational behaviors (disturbance, violence...) and expressions of negative moods, which had ledto interpersonal difficulties and parent-child conflicts. With behavior therapy techniques, we effectively improved the patient’s problem behavior, and increased her capacity for self-care and self-control, thusenhancing her self-confidence and self-esteem. Nursing staff empathized with the mother’s reaction and emotional conflicts when her daughter was first diagnosed with ADHD. After the patient and her mother had been provided with emotional support, disease-related care and guidance, and parent-child interaction skills, and their methods of discipline had been adjusted...etc., the patient and her mother were able to establish a structured lifestyle, and achieve a state of well-being despite the disease. This case report describes the conduct of nurses taking care of adolescent ADHD cases. In addition to monitoring drug effects, behavioral therapy can improve the patient’s level of disturbance and impulsivebehavior and help him or her to learn the skills of emotional adjustment. Parents who participate in behavioral therapy programs can also learn parent-child interaction skills, which can facilitate positive parent-child interaction and proper treatment of the disease, while increasing the patient’s confidence inand capacity to adapt to life after discharge from hospital.

並列關鍵字

Behavior therapy ； Attention-deficit/ Hyperactivity disorder