運用自我肯定訓練合併認知治療於改善門診一位低自尊個案之護理經驗

Nurses' Assertiveness Training and Cognitive Therapy Experiences With an Outpatient Suffering From Low Self-Esteem

本文乃筆者運用自我肯定訓練合併認知治療於低自尊個案之護理經驗，護理期間為91年1月2日至同年4月10日共9次的護理指導門診，期間以整體性護理評估為指引，歸納個案主要健康問題為：（一）個人因應能力失調，（二）長期性低自尊。筆者運用自我肯定訓練合併認知治療之演練，以同理心傾聽、關心、接納和尊重個案；護理措施：（1）建立開放、信任的治療性關係，協助個案能夠接受自己。（2）協助個案尋找方法，將目前負向的想法與感受，轉為預達到的目標或需要的動力。（3）與個案共同訂定目標，提供自我肯定訓練之計畫：擴展個案的自我審查，肯定個案的優點，鼓勵個案探索自己的需要，幫助個案學習說「不」及更自信的擁護自己。（4）引導個案探討其自動化思考及模式，並於會談時進行駁斥思考的練習。（5）討論其壓力因應的模式，並指出個案慣用的壓抑、逃避對處理情緒及問題的負面影響。提供個案有成功的經驗，灌注理想，鼓勵她建立志向，並協助他懂得去防衛任何侵犯自我知覺的事物，是提高自尊的重要法則。故合併運用自我肯定訓練與認知治療，可協助個案矯正扭曲的認知，建構自我肯定的行為，以新的看法與態度來產生健康的心情與適應性的行為。

The experiences during nine meetings with a psychotherapy outpatient suffering from low selfesteem between 1/1/02 to 4/10/02. Using comprehensive nursing assessment practices for guidance, two conclusions were arrived at regarding the patient’s mental health: a) an imbalance in individual response ability, and b) long-term problems with low self-esteem. This assessment was used to help the authors practice appropriate nursing skills associated with assertiveness training and cognitive therapy and to establish a trusting, caring, and accepting relationship with the client. The treatment plan included attempts to increase personal confidence and to promote suitable skills for improving living functions, enhancing relationships, and practicing social behavior.