運用行為治療於一位思覺失調症患者的護理經驗

本文為利用行為治療來幫助一位思覺失調症個案改善其暴力破壞及重覆干擾行為的照護經驗。護理期間為2014年3月1日至8月21日。因個案有被害妄想、衝動控制差，在住院中頻繁出現干擾及暴力破壞行為，故藉由精神科五大層面評估為架構，經三班觀察、會談來收集資料，發現主要健康問題有：思考過程紊亂／與妄想思考；潛在危險性對他人、物品的暴力行為／與認知障礙、焦慮狀態有關；個人因應能力失調／與衝動控制差、缺乏相關壓力因應技巧有關。藉由展現真誠、一致性的態度與個案及主要照顧者建立關係，並且每週與其固定會談、與個案討論檢視自己的行為並教導個案學習新的、合適的發洩情緒方式，與個案、家屬、醫療團隊討論訂定行為約定，初期個案態度防備、憤怒，但藉由工作人員一致性的態度和共同照護，還有家屬的配合，個案慢慢可以接受並且學習控制自己、減少問題行為。期待能藉由此護理經驗的分享，提供臨床護理人員作為照護此類個案的參考。

關鍵字

思覺失調症；行為治療；暴力

並列摘要

The purpose of this article is to describe a nursing experience of being with a patient who has suffered from schizophrenia, and whose violent and repetitive interfering behaviors were improved through the use of behavioral therapy. We have adopting the application of nursing care from the 1st of March 2014 to 21st of Aug, 2014. The patient was evaluated by using psychiatric mental health nursing assessment, in which three major health problems of this patient were identified: altered thought processes, risk of violence, and inefficient coping skills. The medical team and the patient’s mother have worked together to ensure the behavioral therapy was conducted in consistence. After having established the nurse and patient therapeutic relationship and demonstrated appropriate ways to manage anxiety, the patient learned to verbalize several ways to control his anxiety and to decrease violent and interfering behaviors gradually. We found that behavioral therapy is an effective intervention for reducing the patient’s violence and interfering behaviors who have schizophrenia.