照顧一位慢性精神分裂症病人重返職場照護之護理經驗

Nursing Care Experience in Assisting a Chronic Schizophrenic Patient to Return to Work

沈宜慧(Yi-Hui Shan) ； 張丞淯(Cheng-Yu Chang)

《源遠護理》 6卷1期 (2012/05) Pp. 65-74

https://doi.org/10.6530/YYN.2012.6(1).08

摘要

本文描述一位慢性精神分裂症病患接受就業照護過程受幻聽症狀嚴重干擾，人際關係處理與應對不適應、無法達到工作要求，而產生挫折感缺乏就業動機之護理經驗，護理期間為2008年10月03日至2009年03月10日。筆者以五大層面護理評估為架構，藉由觀察、會談、直接護理等方式收資集料，加以歸納分析個案有焦慮、感覺及知覺改變：與無外在刺激但感受到知覺經驗有關；無效性因應能力等護理問題，擬定個別性護理計畫，提供立即性、持續性及完整性的護理，並透過陪伴、溝通、深呼吸及傾聽等技巧，建立良好治療性人際關係，協助區分幻聽與現實的差異與轉移注意力之技巧，協助個案減少因幻聽干擾產生的焦慮行為，引導對工作正向期待參與規劃職業復健訓練，鼓勵表達工作所遭遇問題並適時修正，以合宜的因應策略有效處理工作壓力，進而改善個案的人際互動及增進自我的就業調適能力，重返職場適應社會生活，希望能藉此護理經驗，提供照護此類病患之參考。

關鍵字

精神分裂症 ； 就業照護 ； 家庭因應

並列摘要

This paper describes the 5-month nursing care experience rehabilitating a chronic schizophrenia patient with severe auditory hallucinations. The patient was frustrated and lacked motivation to work caused by maladjustment in interpersonal relationships and inability to fulfill job expectations. Data collected through observations, interviews and direct nursing care based on the framework of five aspects of the nursing care assessment. The patient's problems included anxiety, senses, altered perceptions without any external stimuli, and ineffective coping. The individualized nursing care plan provided immediate, continuous, and comprehensive nursing care. Techniques used during interventions included companionship, communication, deep breathing exercise, active listening and therapeutic interpersonal relationships. Skills taught included how to distinguish auditory hallucination from reality and diversion that helped reduce the patient's anxiety and interferences from auditory hallucination. A positive attitude toward work, participation in vocational rehabilitation training, proper expression of problems encountered at work, and timely counseling helped the patient to adopt a coping strategy for effective management of work stress and improved his ability and interactions at work. The patient was able to return to his workplace and adapt socially with others.

並列關鍵字

schizophrenia ； job management ； family coping