運用生命回顧及復原力於一位活動限制老人憂鬱之護理經驗

An Experience Applying Life Review and Resilience to a Geriatric Patient With Functional Limitations and Depression

李佳蓉(Chia-Jung LI) ； 王佳慧(Chia-Hui WANG) ； 林秋芬(Chiou-Fen LIN)

《護理雜誌》 66卷1期 (2019/02) Pp. 115-122

https://doi.org/10.6224/JN.201902_66(1).14

摘要

老人於疾病適應過程中易因負向自我價值認定產生憂鬱傾向，本文描述一位非預期性脊椎感染導致日常活動功能衰退的老人，因面對患病後家庭角色轉變衝擊導致憂鬱之照護經驗。護理期間自2017年2月28日至2017年4月25日， 筆者依周全性評估發現個案對疾病感受趨於負向並影響自我價值認定，老人憂鬱量表呈中度憂鬱，確立憂鬱為主要健康問題；護理過程運用生命回顧於結構式訪談，以人生各階段為主題，透過自述重新詮釋生命經驗並引導尋找正向意義外，並運用復原力模式評估及分析訪談訊息，經確認個案的保護因子，提供個別性復原力護理措施，以透過丈夫的正向情感支持，提高內心正向力量，以及藉協助回憶育孫快樂經驗，修正依賴他人照護而產生的負向認知與事件詮釋；最後，個案感知家庭成員支持力量並說出正向語句，改變因日常功能缺失產生之負向自我價值感受，經自我統整後，憂鬱程度降低。希冀此護理經驗有助臨床人員參考，以協助患病老人正向面對壓力衝擊事件，減輕負向意念。

關鍵字

老人 ； 憂鬱 ； 生命回顧 ； 復原力

並列摘要

Negative self-values and attitudes during the process of adapting to disease tend to engender depression in the elderly. This case study describes a nursing experience with an elderly patient with depression related to a decline in activity and family role changes related to unexpected spinal infection. The nursing care in this study was provided between February 28th and April 25th, 2017. A comprehensive geriatric assessment was employed, with results showing that the patient was affected by negative self-identity and attitudes. The geriatric depression scale showed moderate depression. Life review strategy was employed in the interview to impart a positive influence on a different life stage and a resilience model was used to interpret the interview transcript. The protective factors were identified and used to develop an individualized nursing intervention that included promoting the support of the husband in order to enhance positive attitude, promoting interactions with the grandchildren in order to increase feelings of independence. Finally, the patient became cognizant of family support and expressed positive words and self-values, which improved depression symptoms. This case report provides a valuable nursing care experience as a reference for similar cases in the future.

並列關鍵字

elderly ； depression ； life review ； resilience

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