運用結構性家族系統觀點於一位強迫症患者之護理經驗

A Nursing Experience of Applying the SFT Method to a Patient Suffering from OCD

胡雯雯(Wen-Wen Hu) ； 莊麗玉(Li-Yu Chuang)

《精神衛生護理雜誌》 9卷1期 (2014/10) Pp. 30-40

https://doi.org/10.6847/TJPMHN.201410_9(1).0004

摘要

本文乃筆者運用結構性家族系統觀點協助一位強迫症個案之照護經驗。護理期間自100年2月1日至100年3月7日，以家庭評估及整體性評估架構，進行觀察、直接護理與會談方式收集資料及評估，確立個案護理問題：1.無效性因應能力；2.家庭因應能力失調：妥協性；3.長期性低自尊。護理過程中，透過治療性人際關係的建立，以同理心接納、尊重個案，運用暴露／不反應的行為治療技巧緩和個案的強迫行為強度，其重複檢查開關的行為頻率由10－12次／天降為5－6次／天；並以結構性家族系統觀點作為護理介入的依據，運用重整家庭結構的技巧修正家中不合宜的互動規則、增進家庭成員能彈性轉換系統間的角色，以及建立家庭成員間明確的界限。分散家人對個案『疾病』的專注力，增進個案的自我分化，個案逐漸能控制情緒，強迫症狀緩和，出院轉歸正常作息及生活。運用系統觀點照護個案，能減弱系統維持症狀的力量，使成員不再共同維持症狀作為家庭的平衡，增進個人及家庭的功能，希望此照護經驗分享，作為日後照護者的參考架構。

關鍵字

強迫症 ； 結構性家族理論

並列摘要

This article describes how the author's nursing experience of applying the Structural Family Therapy (SFT) to a patient suffering from Obsessive Compulsive Disorder (OCD). The observation period was from February 1st to March 7th of 2011. In order able to identify the patient's three nursing problems of having: 1. ineffective coping capability; 2. unbalanced family coping capability of compromises; 3. Long term low self-esteem., we have observed the patient's family, provided them with the instruction of care process, and interviewed the patient and his family members based on data collected. During the nursing process, we accepted and respected the patient through the construction of therapeutic relationship, and adopted the skills of individualized nursing management and behavioral therapy of exposure and nonresponse to help reduce the frequency of the obsessive compulsive behaviors. We later reviewed the patient's behavioral-switching frequency which was found decreased from 10-12 times a day to 5-6 times a day. According to the perspective of SFT, we modified the patient's inappropriate interactive rules with the family, set role boundaries for each of family members, and assisted them in improving their roles changing flexibly within the system. Moreover, by distracting the family members from the fact that the patient was diagnosed with OCD and increasing the patient's self-differentiation, the patient began to develop self-control over emotions and to have his symptoms of OCD eased. The patient finally could return to normal life after discharge from hospital. This case study thus suggests that applying the viewpoint of system to engaging nursing care should possibly enhance and restore the functions of an individual to create a new balance in the family system instead of focusing on the OCD symptoms of the patient. I hope share the nursing experience of this case and expect it to be a nursing example of similar cases for future reference.

並列關鍵字

OCD ； Obsessive Behaviors ； Compulsive Symptoms ； Structural Family Therapy