運用認知治療於一位重鬱症孕婦之護理經驗

The Nursing Experience of a Pregnant Patient Suffering from Major Depressive Disorder using Cognitive Therapy

本文乃筆者運用認知治療理論，照護一位重鬱症孕婦的護理經驗。護理期間為2007年1月17日至2月6日，住院期間以整體性護理評估為指引，評估個案的壓力源有二方面：擔心安眠藥及電氣痙攣治療對胎兒的影響，以及因工作導致生活作息改變、憂鬱情緒，需服用安眠藥協助入睡。歸納出個案的主要健康問題為：一、無效性因應能力。二、睡眠型態紊亂。三、焦慮。個案因負向思考及無望感，出現自殺企圖，筆者先以真誠、關懷、接納的態度與之建立治療性人際關係，進而在護理過程中運用認知治療理論，討論負向思考對其行為、人際關係、家人、胎兒造成之影響，使得個案由原本無望感及自我傷害等負向想法與不良的因應模式，進展到以正向的想法代替負向的思考模式，增加自我調適能力，使日後面對相同情況也可從容應對、恢復對壓力事件的控制感、適切的反應及原有的功能並回到工作崗位上、分娩後可與先生一同照顧新生兒，發揮母親的角色與功能。

This article reported the author’s experience of using cognitive therapy to care for a pregnant patient suffering from major depressive disorder from January 17th, 2007 to February 6th, 2007. Based on a comprehensive psychiatric nursing assessment, the patient was found suffering from two major stressors: (1) reliance of hypnotics due to work-associated diurnal disturbances, and (2) anxiety resulting from concerns about adverse effects of hypnotics and electroconvulsion therapy on the fetus. The patient’s three major health problems included inadequate coping skills, disturbed sleeping patterns, and anxiety. Due to the negative feelings of hopelessness, suicide ideation was noted. The author first approached the patient with a sincere, compassionate, and accepting attitude in order to establish a therapeutic relationship, then applied cognitive therapeutic to discuss with the patient the impact of negative thought on her behavior, interpersonal relationship, family relationship, and her baby. As a result, the patient’s feelings of hopelessness, suicidal ideation, and patterns of maladaptive coping skills were improved. Positive thinking and improved coping skills enable the patient to react to the same psychosocial stressors with comfort and ease. A sense of control of the patient’s own environment was established. With help from her husband, the patient could fulfill both her occupational and maternal role after the birth of her child.