運用結構化處置護理一位高功能自閉症青少年之經驗

Applying a Structured Intervention to a High-Functioning Autistic Adolescent

本篇個案報告在說明運用結構化處置策略，協助一位高功能自閉症青少年消除嚴重暴力及重複性干擾行為的護理過程。照顧期間為2002年1月至12月，應用的方法包括：治療性地運用常規和時間表，擬定具體的目標，運用行為的自然結果建立規範，與自閉症巡迴老師合作，設計個別化課程，提供案母情緒與行動支持。結果發現個案的暴力行為消除，社交互動有明顯地進步，且得以繼續完成國中學業，避免造成輟學，降低案母焦慮。護士在護理過程中充分展現治療者的功能，協助個案改變固執想法，營建正向氣氛對個案的療效，且將護士的角色與功能由醫院拓展至家庭和學校。

The nurse-author describes her structured response to the aggressive and stereotypical behavior of a high-functioning autistic adolescent. Methods consisted of the therapeutic application of routines and scheduling, establishing clear expectations, using consequences in response to established rules, cooperating with a periodic autistic teacher, transferring the adolescent to a different junior high school, planning an individual curriculum, and providing emotional and active support to the client's mother. The intervention occurred between January and December, 2002. By the end of treatment, the client was no longer violent, his social interaction skills had improved, and he was attending his classes on a regular basis. Concurrently, his mother's anxiety levels had decreased. The nurse took on several functions normally associated with therapists during the nursing process in her attempt to effect change in the client's perceptions. The author discusses the effectiveness of creating a positive atmosphere and of extending her nursing roles and functions beyond the hospital to family and school settings.