一位躁鬱症個案躁期發作反覆住院之護理經驗

Nursing Experience of a Repeatedly Hospitalized Patient with Bipolar Disorder Undergoing a Manic Episode

10.6142/VGHN.201803_35(1).0011

趙栩綺(Hsu-Chi Chao)；蔡欣玲(Sing-Ling Tsai)

躁鬱症 ； 躁期發作 ； 反複住院 ； 服藥結盟 ； bipolar disorder ； manic episode ； repeatedly-hospitalized ； medical alliance

榮總護理

35卷1期（2018 / 03 / 01）

96 - 103

繁體中文

本文闡述一位躁鬱症個案因自行停藥致躁期發作而反覆住院之護理經驗，於2017年05月12日至06月19日住院期間，筆者藉由觀察、會談及精神科五大層面進行整體性護理評估，確立個案主要健康問題有：一、高危險性暴力；二、無效性因應能力；三、服藥結盟不足等。於護理過程中，秉持以病人為中心的理念，與病人共同討論，並擬定符合需求之個別性護理計劃，除矯正個案的暴力言行外、提供調適技巧訓練為急性期主要護理，於緩和期期間，運用服藥結盟概念，提升個案對疾病與藥物的認知，使其主動接受藥物治療並維持健康狀態，同時將家屬納入治療計劃中，於個案出院後，持續於門診追蹤及電話訪談，以監測症狀及社區生活適應情形，預防疾病復發。期望藉此經驗，能提供護理同仁在未來照護相關個案時之瞭解，運用服藥結盟概念，促進個案對持續治療的動機與意願，順利回歸社區生活。

This article reports on the experience of clinical nurses in treating a patient with bipolar disorder undergoing a manic episode who was re-hospitalized following a relapse attributed to poor medical alliance. During the period of care from May 12, 2017, to June 19, 2017, the author observed and interviewed the patient to evaluate their physical, emotional, intellectual, sociological, and spiritual state. As a result, causes of the manic episode were determined as risk of violence, ineffective coping, and poor medical alliance. In accordance with the patient's needs, the author also discussed a care plan with the patient during the nursing period. The author taught the patient how to understand and cope with their emotions and to correct their violent behavior. With the goal of enhancing medical alliance, an individualized plan of nursing care was designed to improve the patient's understanding of their illness and medication. The author also provided psycho-education for the patient and their family to build medical alliance. Through telephone communication and outpatient department follow-up, the author monitored the patient's symptoms and adaptation to family life after hospital discharge. The patient successfully reintegrated into the community without further relapse. The results of this study can serve as a reference for nursing staff helping re-hospitalized patients with bipolar disorder that are undergoing manic episodes.

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