運用個別懷舊治療減緩一位失智長者焦慮之護理經驗

Application of Individual Reminiscence Therapy to Decrease Anxiety in an Elderly Woman with Dementia

本文旨分享應用個別懷舊治療照顧一位輕度失智女性長者焦慮問題之護理經驗。筆者護理期間為2007年7月1日至2007年8月3日，經由治療觀察、直接護理、會談及與家屬、工作人員多方溝通，運用五大層面進行整體性評估，收集個案資料並確立問題，呈現最主要的護理問題為：焦慮。於每週兩次，每次30分鐘，共八次，運用個別懷舊治療的處理過程，鼓勵個案說出過去及現在的生活故事，並以傾聽、正向回饋、觸摸、接納的態度，激發長者分享人生經驗，產生成就感，提升對自我的肯定。過程經歷啟動階段、融入階段、退縮階段與結束階段，結果發現經歷個別懷舊治療後，長者臉部表情笑容愉悅、語言表達內容增加、社交互動增加，以及減少詢問睡前藥物焦慮行為的發生，其負向情緒及焦慮情形均獲得改善。期望能藉由此護理經驗能提供長期照護機構護理人員作為臨床照護之參考。

The purpose of this study was to share a nurse's experience assisting an older woman with dementia to manager her anxiety. The author provided nursing care to the subject from July 1st, 2007 to August 3rd, 2007. Diagnosis of anxiety was done using a comprehensive assessment approach encompassing five domains. Data were collected through observation, direct care, interviews with the subject and information provided by other nurse and family members. The author implemented a total of eight 30 minute therapy sessions, delivered twice per week using individual reminiscence theory. During the process, the author encouraged the subject to relate her own life story. To strengthen feelings of achievement and achieved self-assertion, listening, giving positive feedback, touching, and acceptance were used to persuade the subject to share her experiences. The process included four stages, including the initiation, immersion, withdrawal and closure stages. It was found that, after the eight sessions, the resident had a happier expression on her face, was willing to express herself more verbally, had more interaction with others, and required medication less frequently to help her sleep. Such implies that the resident's negative emotions and anxiety had improved. This experience may serve as a reference to elderly care institutions for assisting residents with anxiety.