運用King氏理論建立精神病人疾病覺知之過程

Applying King’s Theory to Establish Psychotic Patients’ Awareness of Illness

精神病患的疾病覺知影響其病程發展及治療，本文運用King理論協助一位初次出現精神症狀之病人，藉由分析護理人員與個案間的想法差異，透過有目的互動，促進個案疾病覺知早期建立。個案住院期間（92/1/1-92/1/23）因受精神症狀影響，出現知覺、角色、權力等扭曲，不但造成疾病覺知障礙，影響彼此的判斷、行動，更降低護病互動，阻礙治療目標達成。筆者於護理過程中，分析彼此知覺，尊重並解決護病間差異，了解個案期待，釐清精神病患權力，透過不斷調整護理活動，逐步拉近彼此差異，建立個案疾病覺知，接受生病事實，進而重建信心，回歸社會。此護理經驗，強調檢視及尊重個案及護理人員間感受差異的重要性，實值得臨床護理工作人員重視。

Psychotic patients' awareness of illness affects their treatment and progress. This report described an experience of applying King’s theory to establish a fresh psychotic patient’s awareness of illness as early as possible. Through personal, interpersonal, social systems assessment, the primary nurse found the patient had distorted perception and role, social right misunderstanding resulted in defect of ill-awareness, that also affected the judgment, and behavior, in addition, caused poor nurse-patient interaction and cure goal attainment. During hospitalization (2003/1/1-23), author analyzed perceptual and thinking difference between each other, clarified patient’s expectation and social right. Purposeful interaction approach was implemented to reduce the difference and to build awareness of illness. Consequently, the patient could accept her illness and regain confidence again. Therefore, to examine and respect the different thinking of both the nurse and the patient is important for clinical practices.