一位雙相情緒障礙症引發自殺企圖之護理經驗

Nursing Experience of Caring for a Patient with Suicide Attempt Induced by Bipolar Disorder

馮雅琪(Ya-Chi Feng) ； 余文雯(Wen-Wen Yu) ； 賴美玉(Mei-Yu Lai)

《嘉基護理》 20卷1期 (2020/06) Pp. 35-45

摘要

本文描述一位雙相情緒障礙症病人，以自殺企圖方式逃離壓力之護理經驗。筆者護理期間為2018年1月18日～4月27日，運用五大層面進行整體性評估，並藉由實際觀察、會談、身體評估、理學檢查及查閱病歷等方式收集資料，確立病人主要健康問題：危險性自我殘害、無效性因應能力、情境性低自尊。運用護理措施以病人為中心，提供真誠的態度、陪伴、主動關懷，引導病人正視自殺企圖的導因，共同擬定符合病人之個別計畫，促使能辨識壓力源，學習有效正向因應技巧，進而改善負面思考，矯正自我傷害之行為，增加自我肯定及提升自我價值，出院後電話追蹤，病人未再出現自殺企圖。因病人年紀尚輕，未來路途漫長，建議若能在病情控制穩定時，依據病人專長，透過資源整合機制，輔導未來後續就學或技能發展，並與區段護理師密切持續追蹤，讓病人出院後在病情控制穩定下仍有自給自足的本能，以增加病人認同自己存在的意義與價值。

關鍵字

雙相情緒障礙症 ； 自殺 ； 護理

並列摘要

This study describes the nursing experience of caring for a patient with bipolar disorder who attempts suicide to escape from pressure. The author provided care for the patient from January 18 to April 27, 2018, and used 5 major dimensions to perform an overall assessment. Moreover, this study also collected data using actual observations, interviews, physical assessments, physical examinations, and medical chart review, to confirm the major health problems of the patient: risky self-harm, ineffective response capability, and situational low self-esteem. The author implemented patient-centered nursing measures, including providing the patient with sincere attitude, companionship, and active care; guiding the patient to face squarely the causes of suicide attempt; jointly developing an individual plan meeting the patient's needs to enable the patient to identify the source of pressure, learn effective and positive response skills, and further improve negative thinking, correct self-harm behaviors, increase self-affirmation, and improve self-value. After the patient was discharged from the hospital, this study used telephone follow-ups to collect data, and the patient did not attempt suicide anymore. Because the patient is still very young and will have a long journey in the future, it is advised to guide the patient to continue with education or develop skills in the future according to the patient's expertise using resource integration mechanism if the disease condition can be stably controlled. Moreover, nurses caring for the patient are advised to perform close and continuous follow-ups to enable the patient to maintain the self-sufficient instinct after being discharged from the hospital under stable disease condition to enhance the patient's identity with the meaning and value of own existence.

並列關鍵字

Bipolar Disorder ； Suicide ； Nursing

參考文獻

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