認知行為治療應用於一位精神分裂症個案的護理經驗

Applying Cognitive-Behavioral Therapy to a Patient with Schizophrenia

本文呈現照護一位有被害妄想、聽幻覺等正向症狀干擾的精神分裂症個案，護理過程中，筆者藉由會談、觀察等方式收集主、客觀資料並運用整體性評估，發現個案有（1）睡眠型態紊亂；（2）思想過程改變；（3）感覺知覺改變；（4）社交互動障礙等護理問題，由於本文著重個案對急性期症狀的緩解及自我管理能力，故僅分享思想過程改變及感覺知覺改變等二項護理過程。筆者在民國93年9月3日至10月2日近一個月的護理過程中，先以關懷、真誠的態度，與個案建立治療性人際關係，進而運用認知行為治療，協助個案確認、理解負向自動化思考之存在，及其合併出現的負面情緒、非理性的因應方式。藉由行為控制技巧的教導及實際演練，成功改善個案被害感、幻聽等正向症狀。在電話追蹤中也發現，個案於出院後仍可持續運用認知行為控制技巧緩解妄想及幻聽干擾，增進對正向症狀的自我管理能力及日常生活品質。

The purpose of this article was to describe a nursing experience with a patient who suffered from delusions and hallucinations due to schizophrenia. Through conversation and observation, the authors gathered both subjective and objective data and identified two major nursing problems, as follows: altered thought processes and sensor/perceptual alteration (auditory). During the nursing process, the authors established a rapport with the patient and provided cognitive-behavioral therapy to help him to reduce his irrational beliefs and improve his coping methods. The behavioral therapy enabled the patient to face his negative beliefs, and he developed cognitive-behavioral skills to improve his self-management of delusions and hallucinations. From this perspective, cognitive-behavioral therapy was an effective intervention in the nursing process of caring for this patient with positive symptoms.