運用焦點解決短期諮商於一位重鬱症負向思考患者之護理經驗

Applying Solution Focused Brief therapy to the Nursing of a Depressive Patient with Negative Thinking

本文旨在分享運用焦點解決短期諮商護理一位對自己及所有事件皆抱持著負面看法的憂鬱症病患之護理經驗。護理期間自民國95年2月7日至95年3月20日。筆者藉由觀察、直接護理、會談、量表測驗及五大層面進行整體評估收集個案資料並確立問題，呈現護理問題為：無望感、長期性低自尊、潛在危險性暴力行為、社交互動障礙及睡眠形態紊亂。以溝通實錄模式呈現焦點解決短期諮商護理過程，運用正向的開始、建立對話架構、確立目標架構、尋找例外架構、假設解決架構、讚美等技巧引發個案正向思考、產生行為改變進而解決問題。結果個案於住院期間未再出現自傷行為，其憂鬱情緒及人際關係、自卑感也獲得改善。因此建議護理人員在繁忙的臨床護理可運用短期焦點解決諮商於護理過程中，有助於改善患者憂鬱情緒所造成之負向思考問題。

This case report is intended to share the nursing experience of applying solution focused brief therapy to a depressive patient with negative thinking. From February 7th to March 20, 2006, the authors collected data using observation, direct nursing care, interviews, scales, and holistic nursing assessments. Data analysis revealed the patient's problems to be feelings of hopelessness, low long-term esteem, potential violence toward self, social interaction disturbance, and sleep disturbance. A communication strategy based on solution focused brief therapy was used during the nursing process in order to lead the patient toward positive thinking, behavioral change and ultimately problem solving. The strategy included use of positive initialization, building conversations, setting goals, seeking exceptions, making presumptions, and giving compliments. As a result of the intervention, the patient presented no self-harming behavior during his stay in hospital, while his depressive mood, interpersonal relationships, and low esteem all improved. The article concludes, therefore, that using solution focused brief therapy in the nursing process is an effective strategy for improving depressive patients' negative thinking.