運用韌力理論於一位雙相情緒障礙症個案反覆住院之護理經驗

A Nursing Experience of Adopting Resilience Theory to the Repeatedly Hospitalized Patient Having Bipolar Disorder

10.6847/TJPMHN.201812_13(2).06

陳彥良(Yan-Liang Chen)

韌力 ； 雙相情緒障礙症 ； 反覆住院 ； 因應能力 ； resilience ； bipolar disorder ； repeatedly hospitalized ； coping capability

精神衛生護理雜誌

13卷2期（2018 / 12 / 01）

50 - 59

繁體中文

本文主要是運用韌力理論提升一位雙相情緒障礙症個案的因應能力，促進服藥結盟行為及學習疾病自我管理之護理經驗。護理期間為2015年09月16日至2015年10月21日，藉由觀察、會談及整體性護理評估等技巧收集資料及確立問題，主要護理問題有個人因應能力不足、社交互動技巧不當及服藥結盟行為不足等護理問題。筆者主要使用韌力理論為照護基礎，介入措施包含建立治療性人際關係，傾聽、同理確認逆境經驗，協助個案面對挫折，利用情緒評估量表引導個案自我覺察情緒變化，促進正向思考，有效改善個案的負面情緒及行為，情緒評估指數由2-4分提升至6-7分；並教導自我管理的因應策略，以強化心理適應能力，顯示透過教導尋求內、外在資源、壓力日記和放鬆技巧等危機處理技巧，可改善其因應能力，進而減少疾病復發；提供社交技巧訓練修正不合宜之社交行為，於緩和期運用服藥結盟方案促進個案的服藥結盟行為，顯示個案的疾病和藥物認知均有提升。出院後，藉由電訪、門診追蹤服藥及生活適應情形，以協助重返社區，預防疾病復發。

This paper aims to describe a nursing experience of which the author has used the resilience theory in caring a patient suffering from bipolar disorder, and the theory is believed able to strengthen the patient's capability of accepting medication and managing self-disease. The aforementioned nursing period was from September 16th to October 21th, 2015, and the author has built a strong therapeutic relationship with the patient. According to our observation on the patient and interviews, the major encountered nursing problems could be summarized as: inefficient coping skills, impaired social skills, and non-obedient acts to medication. Thus, we have applied the resilience theory to enhance the patient’s coping capability. Among which, our intervention included building a therapeutic relationship with the patient, helping the patient face adversity and frustration, and guiding the patient to identify emotional changes through the tool of emotional assessment scale. Secondly, we have tried to promote the patient's positive thinking and to improve the patient's negative emotion and behavior. It showed that the patient's emotional assessment scores increased from 2-4 points to 6-7 points. Next, we taught the patient to implement self-management skills for acquiring a better coping capability. Nevertheless, for the purpose of reducing the patient's relapse rates, the crisis management skills were in need, such as internal and external resources, stress diary, relaxation techniques, and as well as welcomed social skills. Consequently, we provided the patient with an adherent therapy to improve his consistent and routine medication. Finally, through telephoning communication, we were able to monitor the patient's symptoms and his adaptation to family life after he discharged from the hospital.

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