運用認知行為治療改善思覺失調症個案其家庭暴力之護理經驗

A Nursing Experience of Applying Cognitive Behavioral Therapy for Patient having Schizophrenia in Domestic Violence

10.6847/TJPMHN.201611_11(1).0005

許毓心(Yu-Hsine Hsu)；張揚琴(Yang-Chin Chang)；許玫琪(Mei-Chi Hsu)

認知行為治療 ； 思覺失調症 ； 妄想 ； 家庭暴力 ； cognitive behavioral therapy ； schizophrenia ； paranoid symptom ； domestic violence

精神衛生護理雜誌

11卷1期（2016 / 11 / 01）

45 - 53

繁體中文

本文闡述運用認知行為治療協助一位出現妄想症狀思覺失調症個案減緩對父母家庭暴力之護理經驗。護理期間為2011年 8月30日至9月30日，經由整體性護理評估發現主要護理問題：高危險性暴力、低自尊、家庭因應能力失調。照護期間、透過認知行為治療及不良功能認知記錄表協助個案了解、評估自我情緒控制和暴力處理技巧，且藉由治療性人際關係的建立，改善個案暴力行為；透過會談修正負向想法，進而提昇自尊心與自我價值感，同時增加個案因應技巧，促進家屬成員間互動，達到有效的溝通，強化家庭因應能力。期望此護理經驗分享，提供臨床護理人員了解有妄想症狀思覺失調症個案家庭暴力的照護需求，如何有效地協助個案出院後控制妄想症狀和穩定情緒，增加合宜的人際互動，家屬亦能與個案發展有效性的溝通和互動方式，來接納個案重返家庭，以及提供運用認知行為治療於臨床照護的特殊經驗。

This article describes a nursing experience of the parents who have suffered from schizophrenia and paranoid symptom under domestic violence. This patient was admitted to our acute psychiatric ward due to delusions, violence and behavioral disturbances from August 30th to September 30th of 2011. Three major nursing problems were identified through holistic nursing assessments: high-risk violence, low self-esteem and ineffective family coping skills. The authors applied cognitive behavioral therapy and cognitive dysfunction record sheet to help the patient understand to evaluate his emotional control and violence management skills by himself. Violent behavior was also decreased through the establishment of therapeutic communication. The patient's negative thinking was modified through intensive interview, and subsequently, which improved self-esteem, self-worth and coping skills. In addition, family positive interactions, coping abilities and effective communication were improved and strengthened. Hopefully, this article could help mental health nurses obtain more understanding of care which the patients having schizophrenia and paranoid symptom would need, and how to stabilize their mood, decrease and control their delusional symptoms, as well as how to help them build appropriate interpersonal interactions. Ultimately, we found that family members would have more acceptance of patient’s returning home from care. Cognitive behavioral therapy could prevent the fore-mentioned patients from violent behavior. We hope that this case report of the application of cognitive behavioral therapy for schizophrenic patients could be a helpful reference to similar nursing situations.

1. American Psychiatric Association (2014). HIV and AIDS. Retrieved from http://www.psychiatry.org/hiv-and-aids
2. American Psychiatric Association=APA(2013).Diagnostic and statistical manual of mental disorders.Washington, DC:American Psychiatric Publishing.
3. Calvete, E.,Orue, I.,Gámez-Guadix, M.(2013).Child-toparent violence: Emotional and behavioral predictors.Journal of Interpersonal Violence,28(4),755-772.
4. Coid, J. W.,Ullrich, S.,Kallis, C.,Keers, R.,Barker, D.,Cowden, F.,Stamps, R.(2013).The relationship between delusions and violence: Findings from the East London first episode psychosis study.Journal of The American Medical Association,70(5),465-471.
5. Fan, C. C.,Chen, Y. Y.(2011).Factors associated with care burden and quality of life among caregivers of the mentally Ill in Chinese society.International Journal of Social Psychiatry,57(2),195-206.
6. Fazel, S.,Gulati, G.,Linsell, L.,Geddes, J. R.,Grann, M.(2009).Schizophrenia and violence: Systematic review and meta-analysis.PLoS Medicine,6(8),e1000120.
7. Haddock, G.,Barrowclough, C.,Shaw, J. J.,Dunn, G.,Novaco, R. W.,Tarrier, N.(2009).Cognitive-behavioral therapy v. social activity therapy for people with psychosis and a history of violence: Randomised controlled trial.British Journal of Psychiatry,194(2),152-157.
8. Heinrichs, N.,Bertram, H.,Kuschel, A.,Hahlweg, K.(2005).Parent recruitment and retention in a universal prevention program for child behavior and emotional problems: Barriers to research and program participation.Prevention Science,6(4),275-286.
9. Hofmann, S. G.,Asnaani, A.,Vonk, J. J.,Sawyer, A. T.,Fang, A.(2012).The efficacy of cognitive behavioral therapy: A review of meta-analyses.Cognitive Therapy and Research,36(5),427-440.
10. Hsu, M. C.,Huang, C. Y.,Tu, C. H.(2014).Violence and mood disorder: Views and experiences of adult patients with mood disorders using violence toward their parents.Perspectives in Psychiatric Care,50(2),111-121.
11. Jones, C.,Hacker, D.,Cormac, I.,Meaden, A.,Irving, C. B.(2012).Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia.The Cochrane Database of Systematic Reviews,4,CD008712.
12. Koen, L.,Vuuren, S. V.,Niehaus, D. J.,Emsley, R. A.(2007).HIV/AIDS risk behavior in South African schizophrenia patients.West African Journal of Medicine,26(1),2-6.
13. Li, L.,Wu, S.,Wu, Z.,Sun, S.,Cui, H.,Jia, M.(2006).Understanding family support for people living with HIV/AIDS in Yunnan, China.AIDS and Behavior,14(2),509-517.
14. Malik, N.,Kingdon, D.,Pelton, J.,Mehta, R.,Turkington, D.(2009).Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: Relapse and recovery at 24 months.Journal of Clinical Psychiatry,70(2),201-207.
15. Matusiewicz, A. K.,Hopwood, C. J.,Banducci, A. N.,Lejuez, C. W.(2010).The effectiveness of cognitive behavioral therapy for personality disorders.Psychiatric Clinics of North America,33(3),657-685.
16. Morrison, A. K.(2009).Cognitive behavior therapy for people with schizophrenia.Psychiatry,6(12),32-39.
17. Moskowitz, D. A.,Seal, D. W.(2011).Self-esteem in HIV-positive and HIV-negative gay and bisexual men: Implications for risk-taking behaviors with casual sex partners.AIDS Behavior,15(3),621-625.
18. Prochaska, J. O. (ed.),Norcross, J. C. (ed.)(2007).System of psychotherapy: A transtheoretical Analysis.Belmont, CA:Brooks/Cole-Thomson Learning.
19. Sensky, T.,Turkington, D.,Kingdon, D.,Scott, J. L.,Scott, J.,Siddle, R.,Barnes, T. R.(2000).A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication.Archives of General Psychiatry,57(2),165-172.
20. Sexton, T.,Turner, C. W.(2010).The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting.Journal of Family Psychology,24(3),339-348.
21. Turkington, D.(2006).Outcomes of an effectiveness trial of cognitive-behavioral intervention by mental health nurses in schizophrenia.British Journal of Psychiatry,189(1),36-40.
22. 黃宣宜（校閱）, X. Y. (ed.)(2009).最新精神科護理學.Taipei City, Taiwan, ROC:永大書局=Yeongdah Book.
23. 葉人豪, J. H.,葉玲玲, L. L.,黃光華, K. H.,陳快樂, H. K. L.,邵文娟, W. C.,陳宏, H.(2009)。社區精神分裂症照顧者之需要與負荷探討。精神衛生護理雜誌，4(1)，1-8。
24. 衛生福利部統計處（2013）．101年度全民健康保險醫療統計年報．取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?flist_ no=312&fod_list_no=4718 [Ministry of Health and Welfare, Taiwan, ROC. (2013). Statistical annual reprot of medical care, national health insurance. Retrieved from http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4718]

1. 林君黛,王誱竩(2019)。協助一位思覺失調症新移民女性跨文化適應之護理經驗。弘光學報，84，21-33。
2. 魏崇宇,洪昭安(2022)。運用藝術治療之繪圖於慢性思覺失調病人之護理經驗。精神衛生護理雜誌，17(1)，44-52。
3. 謝秀芬,金玉華,林惠珍,林秀玲,李宜玟(2020)。協助一位中年慢性思覺失調症個案回歸社區之家庭護理經驗。精神衛生護理雜誌，15(1)，19-26。
4. 謝秀芬、林秀玲、李宜玟(2019)。運用Watson理論及跨團隊模式照護一位思覺失調症合併十二指腸癌末期之病人。長庚護理，30(2)，263-279。
5. 張馨文,李安瑜(2021)。運用認知行為策略於雙相情緒障礙患者無效性因應能力之護理經驗。精神衛生護理雜誌，16(3)，46-53。