運用動機式晤談法於一位酒精成癮個案之護理經驗

A Nursing Experience of Using Motivational Interview Method for the Alcoholic Addiction Case

10.6847/TJPMHN.201906_14(1).04

林君屏(Chun-Ping Lin)；施雅雯(Ya-Wen Shih)；洪翠妹(Tsui-Mei Hung)；鄒淑萍(Shu-Ping Chou)

動機式晤談法 ； 酒精成癮 ； 行為改變 ； motivational interviewing ； alcoholism ； behavior change

精神衛生護理雜誌

14卷1期（2019 / 06 / 01）

34 - 43

繁體中文

本文為運用動機式晤談法於一位飲酒近20年，導致生理、心理、社會等層面受到威脅的個案之護理經驗，護理期間為106年4月7日至5月11日，收集五大層面整體性評估，確立主要健康問題有無效性保護能力、無效性因應能力。筆者在個案酒精戒斷期，透過酒精戒斷症狀臨床評估量表（CIWA-Ar），密切評估戒斷症狀嚴重程度，和團隊討論給予藥物調整，減緩個案身體不適症狀，鼓勵攝取均衡飲食，以維持體液電解質平衡，教導睡眠衛生，使其獲得滿意的睡眠品質。在個案身體狀況穩定後，評估其缺乏戒酒動機，故筆者運用動機式晤談法協助個案找出維持停酒方法，出院後運用戒酒小幫手app及攜帶型酒測器，自我檢測每日回報醫療團隊，透過圖表做每日、週、月數據分析了解戒酒成效，和其他酒癮個案比較，激勵戒酒成功動力，並記錄自己戒酒心得，提升其可成功停止飲酒的信心及能力。出院後六個月電話追蹤，可維持滴酒不沾並找到管理員的工作。由此可知，護理人員運用動機式晤談法可協助酒癮個案成功停酒，故筆者建議將動機式晤談法納入酒癮個案護理措施常規中，整合醫療和社區照護資源，出院後安排專人長期追蹤，提供持續性的照護來降低酒癮個案復發、減少醫療成本及提高護理品質。

This article was based on a nursing experience of using motivational interviews to care for a patient who had been drinking for nearly 20 years. The following major health problems were found as invalidity protection and ineffective coping. The author closely monitored the patient's severity of withdrawal symptoms and adopted a careful intervention to relieve the patient's physical discomfort and encouraged a balanced diet to help the patient maintain electrolyte balance. After the physical condition of the patient was stabilized, the author assessed the patient lacked the motivation to abstain from alcohol. Therefore, the author used the motivational interview method to help the patient construct concrete plans by himself to prevent a relapse of alcohol abuse. After discharge from the hospital, the patient used a smartphone-based system to self-examine and report the data daily and used the system to discover the effectiveness of alcohol abstinence. Compared with other alcohol addiction cases, this approach more effectively stimulated the motivation of abstinence. In addition, recording and reflecting upon the patients' own experience on a regular basis further improved the patient's confidence and ability to stop drinking. Therefore, the author recommends incorporating the motivational interview method into the routine of the alcohol addiction care wards, integrating medical and community care resources, and arranging long-term follow-ups after discharge from the hospital.

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1. 曾郁心(Yu-Hsin, Tseng);張惠禎(Hui-Chen, Chang);林湘庭(Hsiang-Ting, Lin);邱昕怡(Hsin- I, Chiu);賴宜芳(I-Fang, Lai);彭彥領(Yen- Ling, Peng)(2021)。創建醫院「酒精依賴個案戒酒照護流程」計劃。健康促進研究與實務。4(2)。25-32。