一位精神分裂合併慮病症患者之居家照護經驗

Experiences in Home Health Nursing of a Patient withSchizophrenia Combined with Hypochondriasis Disorder

鍾逸霏(Yi-Fei Chung) ； 謝素真(Su-Chen Hsieh)

《精神衛生護理雜誌》 6卷1期 (2011/06) Pp. 48-55

https://doi.org/10.6847/TJPMHN.201106_6(1).0006

摘要

本文探討一位精神分裂合併慮病症患者長期因妄想干擾出現焦慮、害怕而到處求醫，拒絕護理人員訪視的居家照護經驗。照護期間為2008年7月1日至2009年1月9日。筆者藉由16次居家訪視及3次電訪，經觀察、會談及查閱病歷等方式收集資料，運用五大層面評估，發現個案主要護理問題包括無效性健康維護能力、焦慮及思考過程改變等。筆者以循序漸進方式建立治療性的人際關係，以被動友善及不批判的態度，專注傾聽個案描述過去的就醫經驗，以持續關懷的態度，固定時間家訪及電訪，讓個案有陪伴的感覺；提供精神分裂症疾病單張，與個案討論及引導發現問題；陪同個案返診與醫師共同訂定治療計劃，使其接受口服藥及長效針劑的使用。鼓勵個案自我檢視焦慮程度及說出內心感受，引導個案焦慮時以喜愛的騎腳踏車運動取代四處就醫行為，並運用放鬆技巧訓練減輕其焦慮程度。藉由維護隱私及接納的態度引導個案思考妄想內容的合理性及教導轉移注意力，包括找出興趣及鼓勵家屬共同參與個案的日常活動。期能藉此照護經驗提供臨床護理人員對照護此類個案之臨床照護參考。

關鍵字

精神居家照護 ； 精神分裂合併慮病症 ； 放鬆技巧

並列摘要

This study discusses the experiences of home health nursing with a schizophrenic patient who refused visits by nursing personnel but made multiple clinic/hospital visits due to anxiety and fear brought onby paranoid delusions. The period of nursing care lasted from July 1st, 2008 to January 9th, 2009. Data were collected by means of 16 home visits, three telephone interviews, observations, personal interviews and medical records. Assessment based on the data revealed that the main problem in the nursing care of this patient involved poor health care ability, anxiety, and alterations in the thinking process. The authorgradually and progressively established a therapeutic relationship with the patient through a passive, friendly and non-judgmental attitude, carefully listening to the patient describe past experiences in seekingmedical care. A sustained caring attitude, regular home visits and telephone interviews were implemented to provide the patient with a sense of companionship. Brochures about schizophrenia were provided, anddiscussions were held with the patient. Problems were identified, and the patient was accompanied to the clinic for follow-up visits. In collaboration with physicians a treatment plan was established so that the patient could receive oral or long-acting injected medications. The patient was encouraged to reflecton her anxiety and openly elaborate on it. When anxiety was experienced, the patient was instructed to resort to a much-liked activity, such as riding a bicycle, instead of consulting multiple doctors, and to use relaxation techniques that alleviate anxiety. Through the safeguarding of privacy and the adoption of an attitude of acceptance, the patient was encouraged to reflect on the rationality (or irrationality) ofdelusional thoughts and divert attention from such thoughts by performing enjoyable activities, while her family members were encouraged to participate in her daily life.

並列關鍵字

psychiatric home health nursing ； schizophrenia combined with hypochondriasis disorder ； relaxation techniques