運用正念認知治療照顧一位憂鬱症病人的護理經驗

Nursing Experience in Using Mindfulness-Based Cognitive Therapy in a Patient with Major Depression

10.6142/VGHN.202012_37(4).0006

林怡君(Yi-Chun Lin)；曾淑君(Shu-Chun Tseng)；陳美碧(Mei-Bih Chen)

憂鬱症 ； 正念認知治療 ； major depression ； mindfulness-based cognitive therapy

榮總護理

37卷4期（2020 / 12 / 01）

377 - 384

繁體中文

本篇是照護一位因無法應付工作、生活問題等壓力事件，導致憂鬱症復發吞藥自殺而住院治療病人的護理經驗。護理期間自2016年10月12日至11月13日，藉由實際觀察、會談、傾聽及五大層面進行整體性評估，發現主要健康問題有高危險性自傷、睡眠型態混亂及無效性因應能力等健康問題。因病人負向思考強烈，護理期間以真誠、接納及同理心建立信任的治療關係，教導病人及太太運用覺察呼吸、身體掃描、快樂經驗日記及常規活動正念覺察等正念認知技巧，並協助其察覺憂鬱症狀及不當的因應方式間的關連，學習正向的問題解決方法，以提升其自我察覺能力及對壓力的因應能力，進而能重建自信與自我價值。出院後病人在工作及生活的壓力情境能運用正念認知治療技巧，未再出現自傷想法。建議可於在職教育的課程增加正念認知治療相關知能及引導技巧，俾提供同仁學習正念認知治療的操作技巧，提供憂鬱症病人一個最簡單且有效的自殺防範策略。藉由本文的照護經驗分享，冀望護理人員在照護重鬱症病人時，可運用正念認知治療中斷其負向思考，強化其自我察覺能力及壓力因應能力，進而使其有較佳的生活適應力。

This article describes our nursing experience with a patient hospitalized for depression relapse and suicide attempt caused by his inability to cope with the stress of work and life. We collected data through observation and interview between October 12, 2016 and November 13, 2016, and identified three major problems, including high risk of self-harm behavior, sleep pattern disturbance, and ineffective coping strategies. During the nursing period, we established a trusting relationship with the patient through sincerity, acceptance, and empathy and taught the patient and his wife to use mindfulness and cognitive skills, including breath awareness, body scanning, maintaining a journal of happy experiences, practicing mindfulness exercises, and detecting symptoms of depression and inappropriate responses. Together, these methods helped the patient learn problem-solving to improve their self-awareness and ability to respond to stress, and then rebuild their self-confidence and reaffirm self-worth. We recommend increasing awareness about mindfulness-based cognitive therapy through education, provide clinical care staff with practical skills for learning mindfulness-based cognitive therapy, and provide a simple and effective suicide prevention strategy for patients with depression. We have shared our experience in the hope that the nursing staff can practice mindfulness-based cognitive therapy to interrupt negative thinking, strengthen self-awareness, and improve stress-response ability when caring for patients with major depression, helping them adapt to life.

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