運用行為治療改善一位青少年情感性精神疾患自我傷害之護理經驗

The Nursing Experience of Applying Behavioral Therapy to a Patient of Self-harm Adolescent with Mood Disorders

劉佩玟(Pei-Wen Liu) ； 陳美碧(Mei-Bih Chen) ； 劉淑言(Shu-Yen Liu)

《精神衛生護理雜誌》 13卷1期 (2018/06) Pp. 53-60

https://doi.org/10.6847/TJPMHN.201806_13(1).07

摘要

本文闡述一位情感性精神疾患，因受幻聽干擾及情緒調適障礙，重複出現自傷行為之青少年的護理經驗。於2014年11月3日至11月20日護理期間，筆者透過尊重、接納及關懷的態度與個案建立良好治療性人際關係，藉由觀察、會談等技巧收集資料並進行整體性護理評估以確立問題，歸納個案主要的健康問題有高危險性自傷、知覺感受改變及個人因應能力失調等。照護過程中，除了藥物治療外輔以行為治療，有效矯正個案自傷行為學習正向因應技巧，增進生活適應能力。個案能持續運用自我調適技巧，增進對聽幻覺的自我管理能力直到出院時未再出現自傷行為，達到與疾病共存的生活適應狀態。期望藉此臨床照護經驗，提供護理同仁臨床照顧上之參考。

關鍵字

青少年 ； 情感性精神疾患 ； 自我傷害 ； 行為治療

並列摘要

This article aims to discuss a personal nursing experience of applying behavior therapy to a mood disorder adolescent that had self-harm behaviors many times due to auditory hallucination and emotional maladjustment. The period of nursing care was from November 3rd to November 20th 2014. Data was collected by observation and interview based on mutual respect, acceptance, caring and therapeutic relationships. It was found that self-harm behaviors, abnormal perception and ineffective coping skills affected this patient. Through the intervention of behavior therapy techniques based on therapeutic relationships, his self-harm behaviors and ineffective coping skill were improved gradually. This article validated the importance of the nursing staff who provide nursing strategies to help patients acquire self-surviving techniques, and make his auditory hallucination achieve a stable and comfortable state in self control.

並列關鍵字

adolescent ； mood disorders ； self-harm behavior ； behavioral therapy

參考文獻

江逸萱、陳祐蓉、楊秋月（2013）．慢性精神分裂症病患幻聽與自殺意念的關係．護理暨健康照護研究，9（2），96-105。doi:10.6225/JNHR.09.2.96

Breeman, L. D., Van, L. P., Wubbels, T., Verhulst, F. C., Van, D. E., Maras, A., ... Tick, N. T. (2016). Effects of the Good Behavior Game on the Behavioral, Emotional, and Social Problems of Children With Psychiatric Disorders in Special Education Settings. Journal of Positive Behavior Interventions, 18(3), 156-167. doi: 10.1177/1098300715593466.

Conus, P., Macneil, C., & McGorry, P. D. (2014). Public health significance of bipolar disorder: Implications for early intervention and prevention. Bipolar Disord, 16(5), 548-556. doi: 10.1111/bdi.12137.

Hauser, M., Galling, B., & Correll, C. U. (2013). Suicidal ideation and suicide attempts in children and adolescents with Bipolar disorder: A systematic review of prevalence and incidence rates, correlates, and targeted interventions. Bipolar Disord, 15(5), 507-523. doi: 10.1111/bdi. 12094.

Song, J. Y., Yu, H. Y., Kim, S. H., Hwang, S. S., Cho, H. S., Kim, Y. S., ... Ahn, Y. M. (2014). Assessment of risk factors related to suicide attempts in patients with bipolar disorder.Journal of Nervous and Mental Disease, 200(11), 978-84. doi: 10.1097/NMD.0b013e3182718a07.