照護一位慢性思覺失調症個案之護理經驗

A Nursing Care Experience of A Chronic Schizophrenic Patient with Self-injurious Behaviors

馬億雯(Yi-Wen Ma) ； 劉智如(Chih-Ju Liu)

《馬偕護理雜誌》 12卷2期 (2018/07) Pp. 43-53

https://doi.org/10.29415/JMKN.201807_12(2).0004

摘要

本文為描述一位慢性思覺失調症個案，因長期受幻聽精神症狀干擾，伴隨情緒困擾，導致雙手臂抓破皮、自打耳光等自傷行為，護理期間於2014年12月22日至2015年06月30日，運用身體、情緒、智能、社會、靈性五大層面作整體性評估，發現個案護理問題有營養狀況改變：多於身體需要/與缺乏均衡飲食與運動習慣有關；感覺知覺紊亂：聽幻覺/與精神疾病及缺乏對幻聽的處理技巧有關；社交互動障礙/與缺乏溝通技巧有關。在與個案建立治療性關係後，以幻聽管理策略教導個案，運用轉移注意力技巧，使情緒困擾及自傷行為獲得改善，並透過社交技巧訓練及行為約定，增加個案應對技巧進而改善人際互動能力。同時亦利用課程設計，加入運動課程及均衡飲食計畫，使個案在5個月內體重減輕5.4公斤，達到症狀及體重控制、增加人際互動之目的，期望藉此照護慢性思覺失調症個案之護理經驗，與護理同仁共同分享。

關鍵字

慢性思覺失調症 ； 幻聽 ； 自傷行為

並列摘要

This article describes the nursing care experience of a chronic schizophrenic patient suffering from long term emotional disturbance and auditory hallucination. The purpose of the psychiatric nursing process was to utilize skills to ultimately improve hypo-activity and social withdrawal. By building up a therapeutic relationship with the patient, auditory hallucination may be managed, and the patient’s attentions may be shifted to avoid self-injurious behaviors, such as scratching arm-skin and/or self-slapping. During the nursing period was from December 22nd, 2014 to June 30th in 2015, observation, conversation and physical assessment skills were used to gather information and assess the patient in five aspects, including physical, emotional, intellectual, social, and spiritual health. Individual nursing care plan was tailored to improve nursing problems of altered nutrition: more than requirements, sensory and perceptual alterations:auditory hallucination, and social communication disturbance: communication deficit, and most of all, to improve self-injurious behaviors.This experience would shed some light to health care providers when caring for chronic schizophrenic patients who suffer from social withdrawal, weight gain, communication deficit, and repeated self-injuries.

並列關鍵字

chronic schizophrenia ； auditory hallucination ； self-injurious behavior