運用現實治療理論於反覆出現自殺企圖的物質濫用個案之護理經驗

本文主旨在協助一位物質濫用個案反覆出現自殺企圖，進行現實治療的護理過程。筆者在2008年5月29日至2008年11月30日護理期間，以現實治療理論為架構，對個案進行內在需求（生存、愛與歸屬、權力、自由、興趣）、優質世界、成敗認同與家庭作整體性評估，資料分析後發現有兩個主要問題：一、內在需求不被滿足，則出現自殺企圖。二、物質濫用導致情緒及行為無法自控。照護過程中筆者運用現實治療概念，首先建立共融關係，運用引導改變的「WDEP」模式，協助個案反思自殺企圖及物質濫用其內在需求，而所出現的行為及導致的結果，此外，亦引導個案反思對自己內在需求之正向因應策略。在引導個案對自殺企圖及物質濫用反思的過程中，個案從迴避、轉移話題到主動尋求諮詢，顯示個案已能應用正向態度面對自己的內在問題。因此，此次的照護經驗，深讓筆者體驗到以現實治療理論為基礎的臨床實務是值得推廣的照護模式。

關鍵字

現實治療；內在需求；自殺企圖；物質濫用

並列摘要

This article presents the 6-month nursing interventions of a substance abuse patient who had repeated suicide attempts. Based on the framework of reality theory to assess the patient's internal demands (survival, love and belonging, power, freedom, and interests), high-quality world, identification of success and failure, and family. Two major problems were 1) unmet internal demands lead to suicide attempts and 2) substance abuse caused uncontrollable emotions and behavior. The concept of reality therapy established a compatible relationship with the case, the WDEP (Wants, Doing, Evaluation, and Planning) model assisted to reflect on the behaviors and consequences of substance abuse and suicide attempts, and guided the case to ponder on positive response strategy to internal demands. The turning point was noted when the case transited from avoidance and changing topics to actively seeking consultation, which indicated that the case was able to be positive and face the internal problems. The use of reality therapy theory in nursing intervention is an effective caring model.

並列關鍵字

reality therapy ； internal demand ； suicide intention ； substance abuse

國際替代計量

運用現實治療理論於反覆出現自殺企圖的物質濫用個案之護理經驗

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