照顧一位雙極性情感疾患鬱期發作患者的護理經驗

Experiences Gained in Nursing a Depressed Patient with Bipolar Mood Disorder

藍綺華(Chi-Hua Lan) ； 陳錦茗(Chin-Miing Chen) ； 歐麗玲(Li-Ling Ou) ； 謝玉萍(Yu-Ping Hsieh)

《精神衛生護理雜誌》 5卷1期 (2010/10) Pp. 57-65

https://doi.org/10.6847/TJPMHN.201010_5(1).0007

摘要

本篇報告為協助一位處於憂鬱狀態、有自殺意念之雙極性情感型疾患個案，面對負向自我評價的護理經驗。住院期間以身體、情緒、智能、社會及心靈層面做整體性的護理評估，歸納個案護理問題為：（一）潛在危險性對自己的暴力、（二）長期性低自尊、（三）無效性因應能力。護理期間透過真誠、溫暖、一致的態度與個案建立良好治療性人際關係，藉由關懷及陪伴，了解個案內心的感受，協助個案緩解情緒困擾與避免自殺行為的發生，適時提供心理支持與教導壓力因應的方法，鼓勵個案參加病房人際互動團體，經由人際互動團體中自我探索，學習正向的經驗，增加問題解決能力，藉由改善負向思考與行為，減輕憂鬱的情緒，進而提昇自尊心與自我價值感。結果顯示經由密切觀察情緒變化與教導情緒抒解方法，個案未再出現自殺的想法與行為；在團體中透過彼此分享的過程，能夠適時表露自我想法與了解負向思考可能產生之影響，並學習問題處理的技巧，藉由成員的回饋中獲得正向經驗，進而增加自我的肯定。

關鍵字

雙極性情感疾患 ； 低自尊

並列摘要

This report is about the experiences gained in nursing a depressed patient with bipolar mood disorder undergoing suicidal ideation and negative self-evaluation. During the patient's hospitalization, nursing assessment was made on the basis of aspects of the patient's physical, emotional, intellectual, sociological, and spiritual state. The problems encountered were sorted into three categories: 1) Potential violent self-endangerment. 2) Long-term low self-esteem. 3) Inability to adapt effectively. By being genuine, warm, and consistent we were able to form a good therapeutic relationship with the patient. By being caring and companionable, and by providing timely mental support and stress reduction therapeutic techniques we were able to understand his inner feelings and help him to resolve emotional issues and thereby avoid suicidal behaviors. We also encouraged the patient to participate in the hospital's social activities and workshops. In the course of group interaction, he underwent self-discovery, acquired constructive knowledge, and gained problem-solving skills, transforming his negative thinking and behavior, reducing his depression, and enhancing his self-esteem/self-worth. Through watchful observation of the patient's mood changes and the teaching of stress reduction techniques, we have to date eliminated the patient's suicidal ideation and behavior. In group settings, the patient experiences the process of sharing, expresses his opinion in a timely manner, understands the influences of negative thinking, learns problem-solving skills, acquires constructive knowledge through other participants' feedback, and experiences enhanced self-affirmation.

並列關鍵字

bipolar mood disorder ； low self esteem