應用社會技能訓練與支持性就業於精神病患之護理經驗

A Nursing Experience of Applying Social Skill Training and Supportive Employment to a Psychiatric Patient

本文為分享應用社會技能訓練與支持性就業於一位精神病患之護理經驗。護理期間自民國2004年12月22日至2006年2月17日。筆者藉由會談、觀察及直接護理收集資料，以整體性護理評估分析個案的健康問題，發現個案有無效性因應能力失調、長期性低自尊、思考過程紊亂之護理問題。個案因多次就業失敗，產生嚴重挫折感與無望感，經門診轉介至社區復健中心參與復健。照護期間運用社會技能訓練及支持性就業為護理措施指引，以講解、示範、角色扮演、回饋與社會增強、自我肯定訓練等方法照護，並於工作安置後再提供在職訓練、現場指導及持續性協助與支持，使個案(1)認同職業復健的重要性；(2)穩定參與庇護性工作隊訓練；(3)以正向言語描述自己並自我接納；(4)建構有效同儕支持系統；(5)能持續而穩定的工作六個月，達到勞委會社區化就業服務實務標準之「成功就業定義」護理經驗。期盼本文提供護理人員在社區護理照護中經驗之參考。

The case report intends to share the nursing experience of applying social skill training and supportive employment to a psychiatric patient during December 22, 2004 to February 17, 2006. The authors collected data using the skills of interview, observation, and direct nursing care, and then applied holistic nursing assessment to analyze the patient’s health problems. The problems of ineffective individual coping, long-term low self-esteem, and altered thinking processes were found after data analysis. The patient suffered severe frustration and hopelessness due to unsuccessful experience of employment and then was transferred from outpatient department to community rehabilitation center. The patient received social skill training and supportive employment as the nursing intervention guideline by using the skills of explanation, modeling, role play, feedback and social reinforcement, and assertiveness. Also, on-job training, on-site education, and continuous support were provided to the patient after the patient’s job was settled. Finally, the patient was able to recognize the importance of occupational rehabilitation, participate the protective job training, use positive words for self descriptions and then start self acceptance, and build up effective peer support system. The case can continue the job for 6 months, which achieved the criteria of successful employment defined by Council of Labor Affairs. This report can be a reference to nurses in community caring.