應用擬真娃娃治療於阿茲海默症合併精神行為症狀病人之護理經驗

A Nursing Experience of Applying Therapeutic Doll Therapy on a Patient with Behavioral and Psychological Symptoms of Dementia in Alzheimer's Disease

10.6540/NTJN.202303_25(1).0009

廖紫涵(Zih-Han Liao)；陳祐蓉(Yu-Jung Chen)

擬真娃娃 ； 阿茲海默症 ； 失智症 ； 精神行為症狀 ； therapeutic doll ； Alzheimer's disease ； dementia ； Behavioral and Psychological Symptoms of Dementia

新臺北護理期刊

25卷1期（2023 / 03 / 01）

96 - 106

繁體中文;英文

本文描述應用擬真娃娃治療於一位74歲女性，患有阿茲海默症併精神行為症狀病人的照護經驗，非藥物治療為首要精神行為症狀之首要治療方式，主要用於改善精神行為症狀問題、減緩認知功能退化並提升生活品質，而擬真娃娃治療為非藥物治療方式之一，其應用目前在國內少見，故筆者將分享應用此治療之經驗。病人照護期間為2020年12月20日至2020年12月31日，筆者運用生理、心理、智能、社會及靈性五大層面架構進行之整體性評估，以護理觀察、訪談方式收集主、客觀資料，並使用NPI-Q量表評估病人精神行為症狀嚴重程度及對照顧者造成困擾程度，確立病人有慢性混亂、睡眠型態紊亂及照顧者角色緊張之健康問題，於照護期間針對病人擬定具個別性的擬真娃娃治療的護理措施，藉以改善病人因腦部認知功能退化導致的精神行為症狀，穩定睡眠型態，進而減緩家屬照顧壓力，同時使病人可順利出院。

This article describes the application of therapeutic doll therapy for a 74-year-old woman with behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease. The primary treatment of BPSD, non-pharmacological management, is mainly adopted to relieve the symptoms, slow down cognitive function degenerating, and improve the quality of life. As one of the non-pharmacological managements, doll therapy is rarely applied to people with Alzheimer's disease and BPSD in Taiwan. It is worthy to share this nursing experience. The therapeutic doll therapy was provided from December 20th to 31^(st), 2020. The NPI-Q scale and a holistic assessment of five major aspects were performed through nursing interviews and observations. The NPI-Q scale reveals the stress level of the caregiver and the patient's mental status along with their behavioral symptoms, whereas the five-major-aspect assessment focuses on the patient's physiological, psychological, sociological, developmental, and spiritual aspects. The result of assessments indicated the patient was experiencing health problems of chronic confusion, sleep disorder, and caregiver role strain. The therapeutic dolls were implemented as part of the individualized nursing interventions to improve behavioral and psychological symptoms of cognition decline to stabilize sleep, therefore reducing family members' stress of caregiving and ensuring a successful discharge at the same time.

1. 王凌穎,楊蓉,胡秀英,陳茜(2020)。阿茲海默病患分期照護指標體系的建構。護理雜誌，67(1)，98-105。
   連結：
2. 江昆原(2019)。國立成功大學。
   連結：
3. 高薇淇,郭麗敏,莊宇慧(2018)。淺談失智症遊戲。護理雜誌，66(1)，101-106。
   連結：
4. 許庭榕,黃仲禹(2020)。失智症非藥物治療照護。臨床醫學，85(2)，81-87。
   連結：
5. Balzotti, A.,Filograsso, M.,Altamura, C.,Fairfield, B.,Bellomo, A.,Daddato, F.,Vacca, R. A.,Altamura, M.(2019).Comparison of the efficacy of gesture-verbal treatment and doll therapy for managing neuropsychiatric symptoms in older patients with dementia.International Journal of Geriatric Psychiatry,34(9),1308-1315.
6. Mielke, M. M.(2018).Sex and gender differences in Alzheimer's disease dementia.The Psychiatric Times,35(11),14-17.
7. Ng, Q. X.,Ho, C. Y.,Koh, S. S.,Tan, W. C.,Chan, H. W.(2017).Doll therapy for dementia sufferers: A systematic review.Complementary Therapies in Clinical Practice,26,42-46.
8. Patel, D.,Steinberg, J.,Patel, P.(2018).Insomnia in the elderly: A review.Journal of Clinical Sleep Medicine,14(6),1017-1024.
9. Richter, K.,Kellner, S.,Miloseva, L.,Fronhofen, H.(2020).Treatment of insomnia in elderly patients.Journal for ReAttach Therapy and Developmental Diversities,2(2),129-138.
10. Suzuki, K.,Miyamoto, M.,Hirata, K.(2017).Sleep disorders in the elderly: Diagnosis and management.Journal of General and Family Medicine,18(2),61-71.
11. Vaccaro, R.,Ballabio, R.,Molteni, V.,Ceppi, L.,Ferrari, B.,Cantù, M.,Zaccaria, D.,Vandoni, C.,Ardito, R. B.,Adenzato, M.,Poletti, B.,Guaita, A.,Pezzati, R.(2020).Doll therapy intervention for women with dementia living in nursing homes: a randomized single-blind controlled trial protocol.Trials,21(1)
12. Yilmaz, C. K.,Aşiret, G. D.(2020).The effect of doll therapy on agitation and cognitive state in institutionalized patients with moderate-to-severe dementia: A randomized controlled study.Journal of Geriatric Psychiatry and Neurology
13. 林依儂,官玫秀,方喬玲,楊淑瑜,劉建良(2019)。失智症病人之精神行為問題的藥物治療。臺灣臨床藥學雜誌，27(4)，267-273。
14. 徐灩,吳美鳳(2019)。失智症的精神行為症狀正確治療與照護很重要。彰基院訊，36(3)，18-19。
15. 衛生福利部統計處（2020，9月18日）‧國際失智症日衛生福利統計通報‧取自 https://www.mohw.gov.tw/dl-63592-294f3c91-2032-4f35-a1d2-c94de5f58a78.html

1. 吳佳儀(2023)。護理師在跨科精神心理衛生議題下的自我準備與專業發展。護理雜誌，70(4)，29-35。