運用認知治療於復健期精神分裂症個案之護理經驗

Nursing of a Rehabilitation Patient with Schizophrenia: An Application of Cognitive Therapy

本篇是運用認知治療改善復健期精神分裂症個案焦慮無法出院之護理經驗。照顧期間為95年3月17日至95年6月18日，經整體性護理評估，發現個案有焦慮、思考過程變異及家庭因應能力失調護理問題。藉由治療性人際關係的建立，同理個案擔心被家人遺棄之感受，進而運用認知治療，協助個案發展合適的因應方式。引導個案辨識妄想與事實之差異，以轉移技巧處理妄想的干擾。並主動關心家屬的壓力，協助家屬發展因應策略。因而個案能以合適的因應方式面對住院問題，焦慮症狀有效緩解，妄想症狀逐漸鬆動，家屬亦能與個案發展合宜的相處方式，接納個案重返家庭。

Cognitive therapy can improve patient anxiety. Cognitive therapy was applied in a 48-year-old man who received schizophrenia rehabilitation for 3 months without home leave. Three major nursing problems were identified by nursing assessment, anxiety, altered thought processes, and ineffective family coping. The author established a rapport and found that the patient was worried about being abandoned. Cognitive therapy was applied to help him improve his coping methods. The patient was helped to recognize the difference between delusion and reality. The patient was able to cope with pressures from the relatives responsible for his care and find solutions for these problems. Therefore the patient could face issues related to staying in the hospital and his anxiety was alleviated. Finally, his relatives could establish a good relationship with the patient and accept the patient.