照顧一位慢性疼痛個案對藥物依賴之護理經驗

The Nursing Experience for A Drug-dependent Patient of Chronic Pain

慢性疼痛常併發藥物依賴與嚴重憂鬱，疼痛除會導致病人生理上的不適外，亦會增加個人心理層面及人際互動上的複雜性。本文主要探討一位憂鬱症合併慢性疼痛病人在住院期間因對止痛藥物依賴而不斷的要求注射止痛劑，未滿足其要求，即出現以頭撞壓克力窗、作態性暈倒及敵意等行為來達到操縱之目的。筆者自93年8月2日至93年9月1日照護期間，運用精神科五大層面整體性護理評估得知個案有慢性疼痛、身體心像改變及個人因應能力失調等問題，運用行為治療與個案訂定行為契約，使用正向增強法，改變其行為表現的方式，以負向增強法阻止其不適當的行為，另一方面又建立特定的適當行為，並教導藉由做手工藝及肌肉放鬆等技巧來轉移疼痛，以激勵個案改善其不適當的行為，促進個案自我控制及減少其對止痛劑之需求。經由以上護理措施的介入，個案能學習新技巧處理疼痛，減少對止痛劑的依賴。因此，期盼藉由護理實際經驗，提供臨床護理人員於日後照顧類似病人之參考，以提供適合的護理照護。

Chronic pain is often accompanied by drug-dependence and severe depression. The concern of the medical staff is often limited to the physiological aspect, yet pain would not only cause physical discomfort but also increase the complexity of the mental aspect and personal relationship. This paper discussed a patient of depression and chronic pain, who continued to request for pain relieving injection due to drug-dependence during hospitalization, and exhibited behaviors of striking the head with the acrylic window, intentional fainting, and hostility. The researcher cared for the patient from August 2, 2004 to September 1, 2004, and applied the five aspects of Total Care to conclude that the patient suffered from pain, change of body image, and personal coping disorder, thus, employed methods of behavioral therapy, making behavioral contract, positive reinforcement for metal support and encourage and to change the behavioral expression; while negative practice was adopted to inhibit the “unwelcome behaviors”. Also “welcomed behaviors” were established to encourage the patient correcting the inappropriate behaviors to promote the self-control and less the dependence on drugs. The abovementioned nursing measures helped the patient to realize the feasibility of drug dependence, and learn the new skills to treat the pain, improve the comfort, and enhance the living quality.