一位憂鬱症病患的護理：著重應用認知治療

The Nursing Care of a Patient with Depressive Disorder: Focus on the Application of Cognitive Therapy

吳珮君(Pei-Guin Wu) ； 陳杏佳(Shing-Chia Chen)

《中華心理衛生學刊》 17卷2期 (2004/06) Pp. 93-111

https://doi.org/10.30074/FJMH.200406_17(2).0004

摘要

本個案報告乃著重應用認知治療於照顧一位女性憂鬱症病患的護理經驗，在病患住院四週的護理過程中，經評估後，發現個案的護理問題包括因應能力失調、睡眠型態紊亂、舒適情況變差、潛在危險性暴力朝向自己，而其核心為涉及不良功能的認知問題，故在一般護理措施之外，採Beck理論所發展的不良功能認知表格為特殊護理之措施，以修正個案之認知，並提升其正向情緒。
結果發現與個案不良功能認知有關的情境類型包括角色完成、精神疾病與人際互動。其中，認知扭曲的類型包括負面預期、過度類化、擴大與縮小及情緒推理，核心問題的信念如負責、希望被喜愛，及精神疾病社會烙印。修正經由認知扭曲所產生的自動化思考後，個案情緒部分改善最多為女兒角色完成，最少為疾病的自我概念，認知部分改善最多為工作角色完成，最少為失眠。此外，病患出院後二週內，予電話追蹤，發現亦可恢復其對壓力事件的控制感，有適切的反應及提升出院後的因應能力。文中提出臨床經驗與建議，期待對未來類似憂鬱症病患護理有所助益。

關鍵字

憂鬱症 ； 認知治療 ； 護理

並列摘要

This case report was a nursing experience that emphasizing the application of cognitive therapy to care a female depressive patient. During the four weeks of inpatient care, we found her nursing problems included ineffective coping, sleep disturbance, the negative change of comfortable conditions, and the potential risk of violence toward self. The core of the problems was related to her dysfunctional cognition. Therefore, in addition to general nursing intervention, we applied the Beck's cognitive model as a special nursing intervention to modify the case's cognitive thinking, and to improve her mood.
The results showed that the three kinds of situations related to dysfunctional cognitive thinking were role performance, mental illness, and personal interaction. Among these situations, the case's negative prediction, overgeneralization, magnification and minimization, and emotional reasoning were presented the process of her automatically cognitive distortion. The beliefs of keeping responsibility, hoping to be loved, and social stigma with mental illness are the critical points. In the aspect of emotion, the outcome of the cognitive therapy showed that her role performance as a daughter improved most, while the self-concept related to disease improved the least. In the aspect of cognition, her role performance as worker improved most, while insomnia improved the least. Moreover, followed up her work conditions for two weeks by five phone calls after her discharge from the hospital, it showed that the case could cope appropriately and restored the ability to deal with the stress in the community as well. In this case report, we shared our nursing care experiences and provoked further suggestions focused on the application cognitive therapy for the patient with depression.

並列關鍵字

depression ； cognitive therapy ； nursing care

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