運用認知治療照護一位輕鬱症個案的護理經驗

A Nursing Experience of Applying Cognitive Therapy to a Patient with Dysthymia

10.6847/TJPMHN.201611_11(1).0004

李旻苙(Li-Min Li)；邱綉雯(Hsiu-Win Chiu)；林利珍(Li-Chen Lin)

輕鬱症 ； 認知治療 ； 無效性因應能力 ； dysthymic disorder ； cognitive therapy ； inefficient coping skills

精神衛生護理雜誌

11卷1期（2016 / 11 / 01）

36 - 44

繁體中文

本文描述一位輕鬱症個案的照護經驗，筆者於照護期間民國103年1月6日至2月7日藉由定期會談、情緒支持與關懷、真誠，運用同理心的態度與個案建立治療性人際關係，並利用五大層面護理評估，發現個案有：(1)無效性因應能力、(2)潛在危險性自我傷害、(3)情境性低自尊、(4)睡眠型態紊亂、(5)社交互動障礙等健康問題。透過認知治療的方法，協助個案建立自我察覺之能力，確認影響個案出現不適切言行（如：自傷、自殺等）的偏差認知及負向自動化思考並記錄，予駁斥偏差認知及協助建立正向思考內容進而修正不良功能思考，持續評估其自我傷害想法、環境因應能力及睡眠品質等皆能有效改善，對於壓力源之想法能正向思考，並重建自我價值及信心。個案出院後三週對壓力態度仍有正向之思考模式，且壓力導致個案情緒低落、負向思考、缺乏信心等負面影響已有顯著改善。故藉由本文分享，冀望精神科護理人員在照護不論是憂鬱症或輕鬱症的個案，可運用認知治療改善其負面思考以因應壓力環境。

This paper addresses the experience of caring a dysthymic disorder patient. The nursing period was from January 6th to February 7th, 2014. During the nursing period, we have built up the therapeutic relationship by regular talking, emotional support, and caring with sincere and empathetic attitude. Five facts of psychiatry assessment was applied and five major nursing diagnoses were identified, including a risk of self-harm, inefficient coping skills, situational low self-esteem, sleep disturbance, and social interaction impairment. Using the cognitive therapy, we confirmed that the bias and negative thinking would lead to the patient to behavioral aberration such as self-harm and suicide, etc. We documented them and assisted the patient in establishing his own self-awareness by constructing positive thinking and fixing the negative one. After the therapy, the patient was found improved in coping skills and sleep quality. In addition, the patient was better capable of utilizing positive thinking when facing pressures, recognizing self-worth, and building confidence. After the patient was discharged from the hospital, we did a three-week follow up by making phone calls every once a week. We found that the patient who kept the positive thinking even under gloomy depression, negative thinking and lack of confidence have significantly improved. By sharing this experience, we hope nurses who are in care of depressive disorder cases or dysthymic disorder cases able to practically apply the cognitive therapy to improve patients’ negative thinking and inefficient coping skills with pressures.

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