運用復原理論改善思覺失調症病人自傷行為之護理經驗

A Nursing Experience of Using Recovery Theory to Improve the Patient Having Self-Harm Behavior

劉幸愉(Hsing-Yu Liu) ； 林美伶(Mei-Ling Lin) ； 馬維芬(Wei-Fen Ma)

《精神衛生護理雜誌》 10卷1期 (2015/11) Pp. 26-33

https://doi.org/10.6847/TJPMHN.201511_10(1).0004

摘要

本文是描述一位長期經歷幻聽、控制妄想而辱罵父母導致內心充滿愧疚感，並出現撞頭自傷行為的個案。筆者於護理期間2014年7月05日至2014年9月10日，利用觀察及會談等方式收集資料，運用五大層面整體性評估，確立問題包含感覺及知覺紊亂-聽覺、思考過程紊亂及無效性因應能力。藉由復元理論幫助個案提升自信心，加強因應能力，促進正向思考，改善症狀及加強社交能力，並利用心理演劇團體之力量幫助個案體認到非獨自一人和精神症狀對抗，激發復元的內在力量。期間筆者以陪伴、傾聽、關懷及尊重的態度，建立治療性關係，並利用復元理論的正向觀點，重新幫助個案定義疾病對人生的意義，有效激發個案內在力量，在症狀改善，社交互動及心理層面皆獲得正向的提升，以及家屬的支持下，成功出院返家，進行社區生活的重建。

關鍵字

復元 ； 自傷 ； 思覺失調症

並列摘要

The paper aims to describe the experience of a patient who has suffered from a long-term auditory hallucination and delusion symptoms. The patient had symptoms of cursing his parents because of being controlled by delusion, and it later resulted in his guilt feeling and self-harm behavior. The patient then underwent a process of nursing assessments which were observed and interviewed by the researcher, and were identified three major nursing problems: sensory integrated dysfunction, , altered thought processes and ineffective coping with matters. We gave the patient a nursing care plan based on the Recovery Theory whose application helps the patient regain confidence and enhance self-managerial ability. By providing with using the positive thinking of Recovery Theory on the patient, we helped him understand through attending psychodrama groups where he was not alone while fighting with the disease. In addition, in the nursing process, we have tried to help reduce the patient’s guilt feeling without hurting himself. In order able to establish a therapeutic relation, we have also adopted caring and positive attitude of Recovery Theory to assist the patient in redefining the meaning of illness, improving the skill of dealing with psychiatric symptoms, enhancing better social interaction, and increasing psychological well-being. Meanwhile, with family support, the patient has successfully returned home and society.

並列關鍵字

Recovery theory ； self-harm behavior ； Schizophrenia

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