運用藝術治療之繪圖於慢性思覺失調病人之護理經驗

Nursing Experience of Using Art Therapy Drawing in Patients with Chronic Schizophrenia

魏崇宇(Chung-Yu Wei) ； 洪昭安(Chao-An Hung)

《精神衛生護理雜誌》 17卷1期 (2022/04) Pp. 44-52

https://doi.org/10.6847/TJPMHN.202204_17(1).06

摘要

本文個案罹患思覺失調症多年，缺乏病識感，長期受妄想症狀干擾，未規則服藥，而整體功能退化，影響人際溝通、社交能力、日常生活之自我照護，故藉由藝術治療之繪圖方式協助改善症狀，建立病識感之護理經驗。照護期間為2019年7月25日至2019年8月16日，以直接照護、會談、病歷回溯、五大層面整體性評估方式收集資料，歸納主要護理問題為無效性因應能力及無效性健康維護能力。筆者藉由一連串繪圖引導，使個案敞開心胸，面對過往不如意之人事物，協助探索曾有的正向經驗、重建自信，並藉由畫筆及色彩的真實筆觸增進現實感之建立，提升因應能力及合宜宣洩情緒；過程中適時應用自我揭露、示範，催化彼此的信任及分享，最終能察覺自己的疾病角色，並學會面對及處理疾病相關問題，讓病情獲得有效控制，改善其健康維護能力。此經驗肯定藝術治療的應用價值，建議未來照護此類個案時，可依據其個別性，適時藉由照護者之示範、主題式的引導以融入繪圖過程，以達最佳之療效。

關鍵字

慢性思覺失調症 ； 藝術治療 ； 繪圖 ； 護理

並列摘要

This report presents the case of a patient with chronic schizophrenia and long-term delusional symptoms. Moreover, his irregular medication use resulted in the degradation of his overall function, thereby affecting his social skills and self-care abilities. We applied drawing-based art therapy as the care plan from July 25, 2019, to August 16, 2019, to alleviate the patient's symptoms and establish disease awareness. Direct care observations, interviews, a patient medical history review, and assessments of the five schizophrenia dimensions revealed his ineffective coping and health maintenance. Through the art therapy approach, we guided the patient in a friendly manner to draw aspects of his life, such as his memorable good or bad experiences, gaining his trust through nurses' self-disclosure. Art therapy encourages patients to express themselves through drawing to enhance their self-understanding as well as to relive painful illness experiences and address the negative feelings appropriately. Moreover, it assists patients in evoking previous positive experiences that help rebuild self-confidence and improve coping abilities. The achieved self-understanding further results in improved medication compliance. In the future, nurses' demonstration and thematic guidance can be integrated into drawing-based art therapy in accordance with the patient's individual needs to optimize benefits.

並列關鍵字

schizophrenia ； art therapy ； drawing ； nursing

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