運用認知行為治療改善思覺失調症個案其家庭暴力之護理經驗

A Nursing Experience of Applying Cognitive Behavioral Therapy for Patient having Schizophrenia in Domestic Violence

許毓心(Yu-Hsine Hsu) ； 張揚琴(Yang-Chin Chang) ； 許玫琪(Mei-Chi Hsu)

《精神衛生護理雜誌》 11卷1期 (2016/11) Pp. 45-53

https://doi.org/10.6847/TJPMHN.201611_11(1).0005

摘要

本文闡述運用認知行為治療協助一位出現妄想症狀思覺失調症個案減緩對父母家庭暴力之護理經驗。護理期間為2011年 8月30日至9月30日，經由整體性護理評估發現主要護理問題：高危險性暴力、低自尊、家庭因應能力失調。照護期間、透過認知行為治療及不良功能認知記錄表協助個案了解、評估自我情緒控制和暴力處理技巧，且藉由治療性人際關係的建立，改善個案暴力行為；透過會談修正負向想法，進而提昇自尊心與自我價值感，同時增加個案因應技巧，促進家屬成員間互動，達到有效的溝通，強化家庭因應能力。期望此護理經驗分享，提供臨床護理人員了解有妄想症狀思覺失調症個案家庭暴力的照護需求，如何有效地協助個案出院後控制妄想症狀和穩定情緒，增加合宜的人際互動，家屬亦能與個案發展有效性的溝通和互動方式，來接納個案重返家庭，以及提供運用認知行為治療於臨床照護的特殊經驗。

關鍵字

認知行為治療 ； 思覺失調症 ； 妄想 ； 家庭暴力

並列摘要

This article describes a nursing experience of the parents who have suffered from schizophrenia and paranoid symptom under domestic violence. This patient was admitted to our acute psychiatric ward due to delusions, violence and behavioral disturbances from August 30th to September 30th of 2011. Three major nursing problems were identified through holistic nursing assessments: high-risk violence, low self-esteem and ineffective family coping skills. The authors applied cognitive behavioral therapy and cognitive dysfunction record sheet to help the patient understand to evaluate his emotional control and violence management skills by himself. Violent behavior was also decreased through the establishment of therapeutic communication. The patient's negative thinking was modified through intensive interview, and subsequently, which improved self-esteem, self-worth and coping skills. In addition, family positive interactions, coping abilities and effective communication were improved and strengthened. Hopefully, this article could help mental health nurses obtain more understanding of care which the patients having schizophrenia and paranoid symptom would need, and how to stabilize their mood, decrease and control their delusional symptoms, as well as how to help them build appropriate interpersonal interactions. Ultimately, we found that family members would have more acceptance of patient’s returning home from care. Cognitive behavioral therapy could prevent the fore-mentioned patients from violent behavior. We hope that this case report of the application of cognitive behavioral therapy for schizophrenic patients could be a helpful reference to similar nursing situations.

並列關鍵字

cognitive behavioral therapy ； schizophrenia ； paranoid symptom ； domestic violence

參考文獻

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