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

A Family Nursing Experience of Assisting A Middle-Aged with Chronical Schizophrenia in Returning to Community

10.6847/TJPMHN.202006_15(1).02

李宜玟(Yi-Wen Lee)；謝秀芬(Hsiu-Fen Hsieh)；林惠珍(Huei-Jen Lin)；林秀玲(Hsiu-Ling Lin)；金玉華(Yu-Hua Chin)

思覺失調症 ； 社區精神衛生護理 ； 服藥信守性 ； 低自尊 ； 家庭護理 ； Schizophrenia ； Community Psychiatric Mental Health Nursing ； Medication Adherence ； Low Self-Esteem ； Family Nursing

精神衛生護理雜誌

15卷1期（2020 / 06 / 01）

19 - 26

繁體中文

本文為運用社區精神衛生護理能力於一位思覺失調症個案之護理經驗，照護期間為2017年8月1日至2017年11月2日。運用電話訪談、面談、居家訪視及五大層面評估後發現個案主要照護需求包括營養多於身體所需、服藥信守性不佳、睡眠型態紊亂、低自尊、個人因應能力失調以及家庭因應能力失調。參照中華民國精神衛生護理學會所發展的社區精神衛生護理實務能力指標，運用「治療性人際關係」、「建構自我」、「藥物管理」、「疾病管理」與「家庭護理治療」做為主要策略。在社區護理師持續三個月介入後，個案可維持症狀穩定，並開始學習面對自己的疾病，除了願意持續服用藥物、維持規律生活作息外，更協助家中事務及從事臨時工作，改善以往因疾病復發而反覆入院之困境及緊張的家庭關係。現今精神衛生強調個案於社區復健之重要性，而家庭對精神疾病個案來說是相當重要的支持及後盾，希望藉由此護理經驗之分享，提升精神科護理師協助思覺失調症個案回歸社區之相關照護知識，亦可做為社區精神衛生照護之參考。

This case study introduced a nursing experience of applying community psychiatric mode to a schizophrenic patient. The nursing care took place from 1st August to 2nd November 2017. Five dimensions of psychiatric nursing evaluation were completed through phone calls, individual interviews, and paying visits. It was found that caring requirements poorly demonstrated various nutrition intake (more than basic bodily needs), barriers to medication adherence, disturbed sleep pattern, low self-esteem, and disabled personal with family coping. According to the community psychiatric mental health nursing index developed by the Psychiatric Mental Health Nurses' Association, Republic of China, we next applied five indexes as therapeutic interrelationship, self-construction, pharmaceutical administration, disease control, and family care. After 3-month intervention, the subject started to face his illness and learned how to tackle problems so the subject took medicine willingly. Also, the subject and his mother could listen to each other and had better communication than ever. Community recovery is a crucial goal to expect for present psychiatric caring cases because family is the major support and backup for psychiatric patients. It suggested that this case provides helpful information of caring schizophrenic patients in community psychiatric nursing as well as a worthy reference for psychiatric professionals.

1. 許毓心,張揚琴,許玫琪(2016)。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。精神衛生護理雜誌，11(1)，45-53。
   連結：
2. 陳慧玲,李依玲,蕭淑貞,黃耀輝,李世凱(2017)。詮釋社區精神衛生護理實務能力於病人及家庭之照護。精神衛生護理雜誌，12(1)，47-58。
   連結：
3. 陳慧玲,李依玲,蕭淑貞,黃耀輝,李世凱(2017)。詮釋社區精神衛生護理實務能力於病人及家庭之照護。精神衛生護理雜誌，12(1)，47-58。
   連結：
4. Addington, D.,Anderson, E.,Kelly, M.,Lesage, A.,Summerville, C.(2017).Canadian practice guidelines for comprehensive community treatment for schizophrenia and schizophrenia spectrum disorders.The Canadian Journal of Psychiatry,62(9),662-672.
5. Caqueo-Urízar, A.,Rus-Calafell, M.,Craig, T. K.,Irarrazaval, M.,Urzúa, A.,Boyer, L.,Williams, D. R.(2017).Schizophrenia: Impact on family dynamics.Current Psychiatry Reports,19(1),2.
6. Duvall, E. M.(1988).Family development’s first forty years.Family Relations,37(2),127-134.
7. Hernandez, M.,Barrio, C.(2015).Perceptions of subjective burden among Latino families caring for a loved one with schizophrenia.Community Mental Health Journal,51(8),939-948.
8. Roldán-Merino, J.,García, I. C.,Ramos-Pichardo, J. D.,FoixSanjuan, A.,Quilez-Jover, J.,Montserrat-Martinez, M.(2013).Impact of personalized in-home nursing care plans on dependence in ADLs/IADLs and on family burden among adults diagnosed with schizophrenia: A randomized controlled study.Perspectives in Psychiatric Care,49(3),171-178.
9. 行政院主計處（2018）．國情統計通報．取自ttps://www.stat.gov.tw/public/Data/861416852YWQBW6Y9.pdf
10. 張國祥,劉玟宜(2014)。應用社區精神衛生護理能力於精神分裂症個案的持續性照護。精神衛生護理雜誌，8(2)，43-50。
11. 楊連謙,董秀珠(2015)。雙極性疾患與思覺失調症照顧負擔之比較研究。北市醫學雜誌，12(4)，297-307。
12. 蔡欣玲,劉玟宜,李錦彪,謝汶玲,陳櫻潔,李世凱,邵文娟(2019).社區精神衛生實證護理實務.臺北市:元華文創.
13. 衛生福利部（2007）．精神衛生法．取自https://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=L0020030