運用認知治療照顧一位重鬱症復發病人之護理經驗

A Nursing Experience of Using Cognitive Therapy in a Patient with Recurrent Major Depressive Disorder

林美珍(Mei-Chen Lin) ； 曾怡菱(Yi-Ling Tseng)

《榮總護理》 37卷4期 (2020/12) Pp. 393-400

https://doi.org/10.6142/VGHN.202012_37(4).0008

摘要

本文為一位因案夫要求其非婚生子入戶籍而發生多次爭吵，出現負向情緒、持續失眠並出現自傷行為，診斷重鬱症復發病人。照護期間自2011年9月10日至2011年10月10日，因病人無法有效因應婚姻不睦引起的憂鬱症狀，常自我埋怨、情緒低落，引發筆者探討動機，經五大層面整體性評估後，擬定睡眠型態紊亂、無效性因應能力、潛在危險性對自己的暴力行為等三項健康問題之護理計畫，教導睡前放鬆技巧、運用睡眠日誌及不良功能認知紀錄表進行認知治療、預防自我傷害等護理措施，達到改善睡眠障礙、增進正向因應技巧及避免自我傷害發生之目標。希望藉由此護理經驗分享，提供未來護理人員照護重鬱症復發病人之參考。

關鍵字

重鬱症 ； 認知治療 ； 睡眠型態紊亂 ； 無效性因應能力 ； 潛在危險性對自己的暴力行為

並列摘要

This article describes the nursing experience of a patient with recurrent major depressive disorder who experienced negative emotions, insomnia, and thoughts of self-harm after a conflict with her husband, who claimed household registration of an illegitimate child. During nursing care from September 10 to October 10, 2011, the patient was unable to cope with depressive symptoms caused by marital discord, resorted to self-blame, and experienced depression. We confirmed sleep pattern disturbance, inability to adapt effectively, and risk of self-harm using five aspects of the comprehensive assessment framework. Moreover, we executed a nursing plan, which included teaching relaxation techniques before sleep, applying cognitive therapy by maintaining a sleep log and cognitive dysfunction record sheet, and practicing interventions to prevent self-harm, to improve sleep pattern, promote coping skills, and prevent self-harm. The nursing experience is a useful reference for clinical nursing care in patients with recurrent major depressive disorder.

並列關鍵字

major depressive disorder ； cognitive therapy ； sleep pattern disturbed ； inability to adapt effectively ； risk for self-directed violence

參考文獻

黃淑儀、宋惠娟(2016)．憂鬱之概念分析．榮總護理，33(2)，204-211。

Adler, A. D., Strunk, D. R., & Fazio, R. H. (2015). What changes in cognitive therapy for depression? An examination of cognitive therapy skills and maladaptive beliefs. Behavior Therapy, 46(1), 96-109.

Bauer, M., Severus, E., Köhler, S., Whybrow, P. C., Angst, J., & Möller, H. J. (2015). World federation of societies of biological psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders. part 2: Maintenance treatment of major depressive disorder-update 2015. The World Journal of Biological Psychiatry, 16(2), 76-95.

Beck, A. T. (2016). Cognitive therapy: Nature and relation to behavior therapy-republished article. Behavior Therapy, 47(6), 776-784.

Ghahramanlou-Holloway, M., LaCroix, J. M., Perera, K. U., Neely, L., Grammer, G., Weaver, J., . . . Lee-Tauler, S. Y. (2020). Inpatient psychiatric care following a suicide-related hospitalization: A pilot trial of Post-Admission cognitive therapy in a military medical center. General Hospital Psychiatry, 63, 46-53.