以服藥聯盟概念改善康復之家思覺失調症住民服藥態度與行為之護理經驗

Nursing Experience in Adapting Concept of Medication Alliance to Improve Medication-taking Attitude and Behavior of a Patient with Chronic Schizophrenia in Halfway House

郭佳慧(Chia-Hui Kuo) ； 張雅雯(Ya-Wen Chang) ； 李坤黛(Kuen-Tai Lee)

《嘉基護理》 22卷2期 (2022/12) Pp. 47-57

摘要

本文以服藥聯盟概念改善一位康復之家思覺失調症住民的服藥態度與行為，護理期間2020年09月5日～2021年3月31日；照護過程中，筆者以觀察、會談、回顧住民資料及整體性護理評估方式收集資料，發現住民主要健康問題為服藥結盟行為不足。本報告參考中華民國精神衛生護理學會所發展的社區精神衛生護理實務能力指標含運用「治療性人際關係」、「藥物管理」、「疾病管理」等護理實務能力，協助住民改善服藥行為；先與住民建立信任治療性人際關係，並評估照護需求，包括：持續接受藥物治療、建構自我與疾病管理。住民在接受個別性照護之後，能規律服藥並降低精神症狀對她的生活影響，本報告所分享經驗，可提供康復之家工作人員照護服藥狀況不佳之住民參考。

關鍵字

思覺失調症 ； 聯盟 ； 服藥結盟 ； 康復之家

並列摘要

Based on the concept of medication alliance, this study aimed to improve the medication-taking attitude and behavior of a patient with chronic schizophrenia. The nursing period was from September 5, 2020 to March 31, 2021. Through observations, conversations, chart review and comprehensive nursing assessment, the main health problem of the patient was identified to be ＂insufficient medication adherence behavior＂. Based on the community mental health nursing clinical competence index developed by the Psychiatric Mental Health Nurses Association of the Republic of China, nursing clinical competence such as therapeutic nurse-patient relationships, drug management, and illness management were applied to assist the patient to improve the medication-taking attitude and behavior. A trustworthy therapeutic interpersonal relationship was built with the patient, and then the care needs were evaluated, including continuous acceptance of medications, and the construction of self and illness management. After receiving the individual care, the patient could take medicine regularly so the impact of psychotic symptoms was reduced. It is expected that the experience shared in this report can provide a reference for workers to care for individual cases who suffer from poor medicine taking in halfway houses.

並列關鍵字

chronic schizophrenia ； alliance ； medication adherence ； halfway house

參考文獻

戎瑾如、邱淑鈴、魏秀靜、林美娟（2008）‧建構社區精神衛生護理能力-自我管理‧精神衛生護理雜誌，3(2)，19-29。https:// doi.org/10.6847/TJPMHN.200812_3(2).0004

李依玲、蕭淑貞、李淑紅、楊麗敏、康云瑄（2008）‧建構社區精神衛生護理能力建構自我‧精神衛生護理雜誌，3(2)，10-18 。 https://doi.org/10.6847/TJPMHN. 200812_3(2).0003

李孟達、毛慧芬、呂淑貞、林克忠（2015）‧臺灣精神康復之家發展現況之探討：文獻回顧‧臺灣職能治療研究與實務雜誌，11(1)，33-49。https://doi.org/10.6534/jtotrp. 2015.11(1).33

康云瑄、李依玲、戎瑾如、黃瑞媛、蕭淑貞（2006）‧建構精神衛生護理師藥物治療護理能力‧精神衛生護理雜誌，1(1)，23-27 。 https://doi.org/10.6847/TJPMHN. 200603_1(1).0006

張國祥、劉玟宜（2014）‧應用社區精神衛生護理能力於精神分裂症個案的持續性照護‧精神衛生護理雜誌，8(2)，43-50。https://doi.org/10.6847/TJPMHN.201401_8(2).0006