運用認知治療於重鬱症患者之護理經驗

A Nursing Experience of Cognitive Therapy with a Major Depression Patient

近年來重鬱症患者逐年增加，且大多具有負向思考，運用認知治療協助患者修正負向自動化思考，及學習以正向思考方式面對問題為一值得嘗試的治療法。本文描述一個月內運用認知治療於一位急性病房重鬱症患者所得到的效益之護理經驗。首先，藉由觀察、會談及運用整體性護理評估等技巧收集資料及確立問題，發現個案對自己或事件抱持負面的看法，也因而具有自殺企圖，而個案所呈現之主要健康問題為：潛在危險性自殺、睡眠型態紊亂及無效性因應能力。透過十次的個別認知治療，使用家庭作業方式訓練個案以正向思考替代負向自動化思考。在措施執行後發現，個案的憂鬱情緒、睡眠品質、因應能力皆有改善和提昇。個案於住院期間無再度出現自殺行為，且出院後仍可維持穩定的情緒，並恢復原有的持家功能及可主動到教會服務。因此建議精神科護理人員可運用認知治療於護理措施中，以協助重鬱症患者改善其負向自動化思考。

The increasing number of major depressive patients with negative thinking warrants that cognitive therapy be recommended to correct negative-automatic thinking and inculcate positive thinking as a way to face problems. The purpose of this paper was to describe the nursing experience and effectiveness of implementing individual cognitive therapy on a patient with major depression in an acute ward over a one-month period. Through observation, interviewing, and comprehensive nursing assessment, the patient's negative thinking toward herself and her problems was identified, and her thoughts of suicide emerged. The following three major health problems were identified: risk of suicide, disturbed sleep pattern and ineffective coping. The patient underwent homework training throughout the ten individual cognitive therapy sessions, and was expected to use positive thinking instead of automatic thinking. After the intervention, the patient's depressive mood, sleep quality, and coping ability were improved. In addition, the patient no longer talked of suicide and was able to show stable emotions, maintain a homework, and attend church activities on her own initiative after discharge. It is therefore, suggested that cognitive therapy can be an effective intervention for nurses planning to care for this group of people.