運用壓力評價因應理論於一位自殺企圖病患的護理經驗

The Applying Stress, Appraisal and Coping Theory in a Patient with Suicidal Attempt as Experience by Nursing Practice

本文旨在探討協助一位服用安眠藥合併燒炭自殺個案，進行評價因應的護理過程經驗。筆者自個案急診處置、住院治療到出院後返院做高壓氧治療期間，以壓力評價因應理論為架構，對個案進行身、心、靈、社會與家庭的整體性評估。護理期間運用觀察、會談方式，進行資料收集，資料分析後發現有三個主要健康問題：家屬因應能力準備度缺乏、對壓力情境呈現負向評價、負向的情緒取向因應行為。照護過程中筆者運用評價概念，引導個案再次審思自殺事件的原因、過程、結果、意義，此外也引導個案反思對壓力情境之正向因應策略。經由引導個案對壓力事件的評價，個案從冷漠拒絕會談到主動尋求諮詢，顯示個案正學習以正向的態度去面對壓力情境。此次照護經驗，深讓筆者體驗到以理論為基礎的臨床實務是值得推廣的照護模式。

The case report described the nursing process of using stress, appraisal and coping theory to help a patient who has committed suicide by taking hypnotics and burning charcoal. The authors applied stress, appraisal and coping theory by doing a holistic physical, psychological, social, spiritual, and family assessment of the patient during the period in which she was under emergency treatment, hospitalization, and followed up with hyperbaric oxygen therapy outpatient management. During the nursing care, the author applied observation and interviews to collect data. After analyzing the data, three major health problems were found: (1) Family coping was insufficient; (2) Negative appraisal to stress situation; (3) Negative emotional orientation coping behavior. The author applied an appraisal concept to help the patient reconsider the reasons, processes, results, and meanings of her suicide event and to reflect by herself on positive coping strategies for stressful situations. During the appraisal period, the attitude of the patient changed from indifference and refusal to being cooperative, seeking advice, and positive as seen by her facial reaction and cooperation. The meaningful nursing care experience of the author finds the need to apply and recommend the theory to nursing care and practice.