- 期刊
以辯證行為治療照顧一位反覆自傷青少年的護理經驗
Applying Dialectical Behavior Therapy in the Nursing Care for An Adolescent with Repeated Self-Harm
摘要
本文描述一位因缺乏情緒調適能力，面對負向情緒反覆自我傷害青少年個案之護理經驗。青少年時期的個案正處於生理心理急遽變化的轉銜期，增加臨床照護上的困難度，於照護過程如何提升個案的因應能力，更是刻不容緩的議題，故引發筆者的動機。護理期間為2021年3月20日至2021年5月15日，運用生理、心理、智能、社會及靈性五大層面護理評估，確立個案主要健康問題為高危險性自傷與社交互動障礙。在高危險性自傷照護過程中筆者以同理、傾聽及個別會談方式，引導個案表達自傷行為的想法，使用辯證行為治療（Dialectical behavior therapy, DBT）－正念、情緒調節、痛苦耐受、人際效能技巧為介入照護措施，以增強個案處理情緒和控制行為的能力，降低自我傷害行為；在社交互動障礙照護上，運用講解、示範、角色扮演、回饋與反覆練習之社交技巧訓練，協助個案發展合宜社交互動並提升自信心。希冀由探究反覆自傷青少年的照護內涵，除了改善個案情緒調適技巧、提升照護品質外，亦能藉由本文的整理及照護過程，進而加深護理人員對辯證行為理論的相關知能，做為未來照護此類個案之參考。
並列摘要
This article describes the nursing experience of caring for an adolescent who engaged in repeated self-harm due to negative emotions and a lack of emotional regulation skills. Adolescence is a transitional period marked by rapid physiological and psychological changes, which complicates clinical care. Addressing the issue of improving the patient's coping skills was crucial and required prompt attention. A comprehensive assessment-including physical, emotional, intellectual, social, and spiritual dimensions-was conducted to identify the main health problems from March 20, 2021, to May 15, 2021. The primary nursing issues identified were high-risk self-harm and social interaction barriers. To enhance the patient's coping skills, the author applied dialectical behavior therapy (DBT), an integrated care model for addressing repeated self-harm. DBT focused on four key areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These approaches were designed to help the patient better manage emotions, control behaviors, and reduce self-harm. To boost self-confidence and develop appropriate social skills, social skills training was implemented. This training included explanations, demonstrations, role-playing, feedback, and repeated practice to address the patient's social interaction barriers. This article deepened our understanding of DBT and provided an individualized care experience, which can serve as a valuable reference for managing similar cases in the future.