運用人際社會節奏治療於一位第一型雙相情緒障礙症躁期發作病人之護理經驗

A Nursing Experience of Applying Interpersonal and Social Rhythms Therapy to the Patient with Manic Episodes in Bipolar I Disorder

10.6847/TJPMHN.201906_14(1).03

許佳茵(Jia-Yin Hsu)；楊秋月(Chiu-Yueh Yang)

人際社會節奏治療 ； 第一型雙相情緒障礙症 ； 躁期發作 ； interpersonal and social rhythms therapy ； bipolar I disorder ； manic episodes

精神衛生護理雜誌

14卷1期（2019 / 06 / 01）

23 - 33

繁體中文

本文描述照護一位躁期發作的第一型的雙相情緒障礙症病人之護理經驗，此病人因未規則服藥、與案夫關係緊張，導致晝夜節奏失序而使疾病復發，筆者運用人際社會節奏治療建立其疾病認知、改善晝夜節奏及人際問題。於2016年8月31日至10月26日護理期間藉由整體性評估，發現病人有「晝夜節奏失序」、「社會節奏不穩定－人際衝突」及「健康維護能力改變－缺乏疾病認知」等三項主要的健康問題。晝夜節奏失序方面，藉由社會節奏表記錄並調整其晝夜節奏，進而教導病人辨識前驅症狀及因應方式；人際衝突方面，運用澄清了解問題癥結點，並藉由事前演練、陪伴會客的過程，化解病人及案夫之間的衝突；健康維護能力改變方面，教導病人及家屬認識疾病及藥物，並提供出院後諮詢資源。結果顯示人際社會節奏治療能增進病人疾病認知、改善人際問題及穩定晝夜節奏。建議護理人員可運用人際社會節奏治療於改善第一型的雙相情緒障礙症病人之疾病認知、人際問題及晝夜節奏，進而減少疾病復發可能。

This article aims to describe a nursing experience to care for a patient with manic episodes from August 31 to October 26, 2016. This patient had difficulties in medication adherence and interaction with her husband, which led to the circadian rhythms disturbance and relapse. We tried to use the interpersonal and social rhythms therapy to improve patient's illness knowledge, circadian rhythms, and interpersonal problems. Three major health problems were identified: ＂circadian rhythms disturbance＂, ＂social rhythm instability - interpersonal conflict＂ and ＂altered health maintenance - lack of illness knowledge＂. As circadian rhythms disturbance, we used social rhythm metric - II to record and adjust the patient's social rhythms and taught the patient to identify the prodromal symptoms and the coping strategies. As interpersonal conflict, we used clarification and explanation skills to understand the key point of the conflicts between the patient and her husband and overcome conflicts by rehearsal preparations and accompanying meetings with her husband. As having altering health maintenance, we taught the patient and her families to understand diseases and drugs and to provide resources after discharge. The results show that the interpersonal and social rhythms therapy can improve patient's illness knowledge, circadian rhythms, and interpersonal problems. We suggest using the Interpersonal Social Rhythms Therapy to improve the patient's illness knowledge, circadian rhythms, and interpersonal problems, as well as to reduce the relapse rate.

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