運用行為治療於思覺失調症服藥不遵從之護理經驗

Nursing Experience of Applying Behavioral Therapy to Patient with Schizophrenia in Medication Non-Compliance

10.29494/LN.202109_22(3).0004

謝秀玲(Hsiu-Ling Hsieh)；陳碧君(Bi-Chun Chen)

思覺失調症 ； 行為治療 ； 不遵從 ； schizophrenia ； behavioral therapy ； non-compliance

領導護理

22卷3期（2021 / 09 / 01）

40 - 54

繁體中文

本文是運用行為治療於思覺失調症個案服藥不遵從而引起幻聽及社交互動障礙之護理經驗。護理期間為2018年6月1日至7月10日。筆者藉由治療性會談及護理觀察方式進行資料收集，並依身體、情緒、智能、社會、靈性等五大層面進行整體性評估，個案因缺乏病識感而不規律服藥出現聽幻覺干擾，沉浸在自我的世界產生社交互動問題，確立個案有感覺知覺紊亂、不遵從、社交互動障礙之問題。首要建立良好之護病關係，每週固定陪伴及治療性會談、安排團體治療學習因應幻聽的策略，運用行為治療改善服藥不遵從及學習合適的社交因應技巧，讓個案和醫療團隊討論訂定行為約定，配合行為治療技巧及案母的支持系統相互協調合作達一致性治療態度，個案由抗拒到被動的配合轉為全然合作的態度，出院後持續主動表示要確實服藥。急性期短暫的住院讓精神症狀獲得控制，然而服藥遵從的行為養成須耗時一段時間，建議出院後轉銜計畫能由居家人員協同延續持續性照護。期待能藉由此護理經驗的分享，提供臨床護理人員作為照護此類個案的參考。

This article is about the nursing experience of applying behavioral therapy to patient with Schizophrenia in medication Non-compliance from the 1st of June to the 10th of July, 2018. The data was corrected through therapeutic interviews, nursing observation methods, and comprehensive conducted evaluation based on five major aspects: physical, emotional, intelligent, social and spiritual. The patient shown health issues including: Sensory disturbance due to lack of illness sensitivity, Non-compliance and Social disorder resulting from immersed into the ego world. It is confirmed that the case has sensory perception disturbances, non-compliance, and difficulties to social interaction. The priority is to establish a good relationship between patients and nurses; weekly regularity companionship and held the therapeutic meetings; arrange group therapy to learn strategies in responding to auditory hallucinations; apply behavioral therapy to improve medication non-compliance, and learn appropriate social skills. Make behavioral agreement, cooperation with behavioral therapy skills and the supporting system from mother of the case coordination and cooperation with each other to achieve a consistent treatment attitude. The case transforms from resistance to passive cooperation and turns to a completely cooperative attitude. After discharged from the hospital, he continues to initiate the medication. A brief hospitalization in the acute phase allowed the psychiatric symptoms to be under controlled. However, it takes a while to develop the behavior of taking medication. It is recommended that the post-hospital transfer plan can be coordinated by family members to continue nursing care. We looking forward to share this nursing experience and provide clinical nursing staff as a reference for caring similar cases.

1. 吳瑋庭,陳杏佳(2015)。運用行為修正方法增進一位思覺失調症患者的健康維護能力。精神衛生護理雜誌，9(2)，39-46。
   連結：
2. 林盈束,曾雯婷(2016)。運用行為治療於一位思覺失調症患者的護理經驗。精神衛生護理雜誌，11(1)，27-35。
   連結：
3. 陳倩妮,程碧君,羅麗華(2018)。急性病房思覺失調症病人藥物認知提升專案。若瑟醫護雜誌，12(1)，54-69。
   連結：
4. 趙梅光,洪翠妹,孫慧芳(2017)。照顧一位罹患思覺失調症新住民之護理經驗。精神衛生護理雜誌，12(2)，35-42。
   連結：
5. Ansari, M. R.,Jahan, M.(2015).Efficacy of cognitive behavior therapy in management of delusion, hallucination in patients with schizophrenia.Indian Journal of Health & Wellbeing,6(5),480-483.
6. Breeman, L. D.,Van, L. P.,Wubbels, T.,Verhulst, F. C.,Van,D. E.,Maras, A.,Tick, N. T.(2016).Effects of the Good Behavior Game on the Behavioral, Emotional, and Social Problems of Children With Psychiatric Disorders in Special Education Settings.Journal of Positive Behavior Interventions,18(3),156-167.
7. Haddad, P. M.,Brain, C.,Scott, J.(2014).Nonadherence with antipsychotic medication in schizophrenia: Challenges and management strategies.Patient Related Outcome Measures,5,43-62.
8. 黃宣宜（校閱）(2015).新編精神科護理學.台北:永大.
9. 鄭可馨,黃惠寬,李正芬,劭文娟,張雅芬(2014)。提升偏遠山區精神病人服藥遵從率專案之成效。醫學與健康期刊，3(1)，77-87。
10. 蕭淑貞（校閱）(2015).行為治療與認知治療．於蕭淑貞校閱：精神科護理概論：基本概念及臨床應用.台北:華杏.