運用關懷理論於一位反覆自殺者之急診照護經驗

Application of Caring Theory in Nursing Care for a Patient with Multiple Suicide Attempts

本篇是描述一位22歲反覆自殺女性患者，因與父親溝通障礙、工作不順及生活壓力大等因素，憤而相約男友於汽車旅館燒炭及割腕自殺。筆者藉由實際觀察、傾聽及提供隱密的會談環境，收集主、客觀資料，並運用Watson關懷理論模式，發現個案有「個人因應能力失調」、「家庭因應能力失調」及「皮膚完整性受損」三項主要護理問題。護理措施先立即提供傷口處理及氧氣治療，而後提供一個隱密的環境，利用關懷、真誠的態度，與個案建立治療性人際關係，進而取得信任感後，教導個案自我情緒管理與家庭之間良好的溝通方式，提供讓個案減輕生活壓力之方法，加強支持系統，並提供符合個案需求之社會資源，進而改善個案在面臨壓力源時，能自我調適及活用因應技巧，且教導如何運用社會資源及轉介，以避免自殺事件之再發生。期望此護理經驗的提出，能在自殺率逐年上升的社會中，與護理人員分享，提供第一線接觸自殺病患之護理措施，冀希能透過第一線完整的評估、支持與提供可利用資源，避免反覆自殺的發生率。

This article describes a nursing experience for a 22-year-old patient with a history of multiple suicide attempts. Facing the difficulty in communicating with her father, poor performance in her job, and life pressure, she attempted suicide with her boyfriend by inhaling carbon monoxide from burning charcoal and cutting her wrist in a motel. Data were collected by means of observation and listening in the private room of the emergency department. With the application of Watson's caring theory and model, identified problems were (1) impaired individual adaptation, (2) impaired family adaptation, and (3) impaired skin integrity. Nursing interventions included providing immediate wound care and oxygen therapy and building a trustful and therapeutic relationship with the patient via a caring and sincere attitude. The patient was instructed emotional self-management, good communication skills with the family, and the methods of stress reduction. Enhancement of the support system and use of social resources promoted the patients coping skills in preventing the attempt of suicide. As suicide rates gradually rise in the recent years, the front-line nurses may provide comprehensive assessment, supportive care, and social resources to prevent recurrences of suicide attempts by patients with a history.