運用行為治療於自閉症個案自殘行為之照護經驗

Nursing Care Experience of Using Behavioral Therapy to Reduce Self-Harm Behavior in a Patient with Autistic Spectrum Disorder

10.6847/TJPMHN.202208_17(2).06

呂保慶(Pao-Ching Lu)；趙珮如(Pei-Ru Chao)；蘇意淳(Yi-Chun Su)；劉建宏(Chien-Hung Liu)

行為治療 ； 自閉症 ； 自殘行為 ； 護理經驗 ； behavioral therapy ； autistic spectrum disorder ； self-harm ； nursing experience

精神衛生護理雜誌

17卷2期（2022 / 08 / 01）

41 - 50

繁體中文

本文是描述自閉症個案因發展遲緩、溝通及表達能力障礙、情緒因應與問題解決能力不足，反覆出現自殘行為，造成臨床照護上的困擾與壓力。照護期間自2018年3月16日至2018年5月17日，筆者以觀察及會談等方式進行五大層面整體性護理評估，歸納出個案存有自殘、社交隔離及自我照顧能力缺失等健康問題。經由醫療團隊、案母及個案共同討論後，依照個案的個別性擬定行為治療計畫內容並執行，藉由行為修正技巧的介入，最終個案能逐步養成良好的因應方式、增加自我控制、參與團體活動並與病友維持良好互動關係，明顯改善自殘、社交隔離及自我照顧能力缺失等健康問題。而於出院後教導家屬與教養機構延續使用此方案並定期追蹤，個案能持續維持良好的行為表現、減少自殘行為發生頻率，可見行為治療運用於此類個案護理照護之成效。期望以此護理經驗提供護理人員臨床照護之參考，以提升自閉症病人之照護品質。

This study evaluated patients with autistic spectrum disorder who have developmental delays, communication and expression dysfunction, emotional reactions, problem-solving deficiencies, and repeated self-harm behavior. The period of nursing care was from March 16 to May 17, 2018. Data were collected through observation and interviews. During nursing care, the following problems were identified: self-harm, social isolation, and self-care deficit. The medical team devised a behavioral therapy treatment plan after discussions with patients and family members. After receiving behavioral therapy, the patients gradually developed coping skills, demonstrated increased self-control, participated in group activities, maintained healthy interactions with other patients, and became significantly healthier. After discharge, we taught family members and institution staff to perform this program continuously and follow-up patients regularly. Patients continued maintaining good behavior and exhibited less frequent self-harm behavior after therapy. Behavioral therapy may improve the quality of care for patients with autistic spectrum disorder. It is hoped that this nursing experience can provide reference for the clinical care of nursing staff, so as to improve the quality of care for autistic patients.

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