運用懷舊治療於一位血管型失智症合併精神行為症狀個案護理經驗

Nursing Experience of Applying Reminiscence Therapy to Care for a Patient with Vascular Dementia and Behavioral and Psychological Symptoms

10.6847/TJPMHN.202212_17(3).06

張如欣(Ru-Hsing Chang)；丁小玲(Sheau-Ling Ding)；林美伶(Mei-Ling Lin)

懷舊治療 ； 精神行為症狀 ； 血管型失智症 ； 護理之家 ； reminiscence therapy ； behavioral and psychological symptoms of dementia ； vascular dementia ； nursing home

精神衛生護理雜誌

17卷3期（2022 / 12 / 01）

43 - 49

繁體中文

本文為照顧一位血管型失智症合併精神行為症狀（BPSD）之護理經驗。個案居住於護理之家，因缺乏環境與認知刺激，有明顯其的精神行為症狀，對照服員出現妄想，與其他住民關係疏遠，出現情緒低落、抑鬱等狀況。筆者於2022年4月5日至5月6日期間，藉由實際觀察、深度訪談、查閱病歷與家屬會談等方式收集資料，並以五大層面評估，確認個案具有思考過程紊亂、知覺感受變異、無望感及自我照顧能力缺失等護理問題。照護過程除了每天固定會談30分鐘，並配合個案身心狀況，介入30-50分鐘的電腦網路媒體輔助之懷舊治療活動，每週1-2次，共進行6次；藉由傾聽及同理，表達關懷態度，建立信任關係，回憶過去經驗，引發並分享想法、經驗、感受。執行懷舊療法後，個案的精神行為症狀改善，包括情緒波動減少、憂鬱情形減輕、且認知功能退化減緩，並能減少照顧者負荷。

This case report involved caring for a patient with vascular dementia and behavioral and psychological symptoms of dementia (BPSD). The patient was a nursing home resident who lacked environmental and cognitive stimulation and exhibited observable BPSD. The patient had delusion toward the caretakers, remained distant from other residents, and exhibited low mood and depression symptoms. From April 5, 2022, to May 6, 2022, the author of this report collected data through actual observation, in-depth interviewed, medical record reviewsed, and interviewed with family members. Through assessment of five major aspects, the author identified that the patient had nursing problems including disordered thought processes, sensory and perceptual alterations, sense of hopelessness, and deficiency of self-care abilities. The care processes included daily consultation for 30 minutes and 30-50 minutes of computer and online media aids of reminiscence therapy activities depending on the patient's physiological and psychological conditions. The reminiscence therapy activities were implemented once or twice per week. A total of 6 therapy sessions were performed. Through listening and empathy, the author expressed an attitude of concern and established a trust relationship with the patient to help the patient recall experiences, as well as elicit and share thoughts, experiences, and perceptions. After applying reminiscence therapy as an intervention, the patient's BPSD improved including reduced emotional fluctuations, alleviated depression, and delayed cognitive degeneration. In addition, the caretaker burden was lightened.

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