運用悲傷輔導於老年喪偶憂鬱患者之護理經驗

Providing Grief Counseling to a Major Depressive Elderly Widower: A Nurse's Experience

老年喪偶是生命中重大的失落經驗更是重大壓力的來源，本文乃照顧一位於喪偶後出現憂鬱症的患者。護理期間95年4月10日至6月07日筆者以整體性護理評估，發現個案憂鬱症狀與悲傷反應相互影響，筆者運用複雜性悲傷量表檢測悲傷反應，確認悲傷反應程度，發現個案無法接受喪偶事實且調適困難，覺得孤單寂寞、無望及無力感，而有自殺意念。筆者因而運用悲傷輔導幫助個案體認喪偶的事實、悲傷情感表達與支持、克服喪偶後再適應的障礙、與死者告別並建立新關係。最後個案可以體認死亡的必然性，接受太太已經死去的事實，並鼓勵個案與自己建立關係，協助老年階段的統整。因此建議護理人員面對老年喪偶憂鬱患者時，謹慎評估失落經驗及悲傷反應，適時介入悲傷輔導，可幫助喪偶老人度過悲傷任務，走出憂鬱的陰霾。

The death of a spouse is both a major loss and a tremendous life stressor for the partner left behind. Such has been shown to be particularly hard on the elderly. This article describes a nurse's experience caring for an elderly patient suffering from major depression resulting from the death of his wife. While providing nursing care to the client, the author, employing holistic nursing assessment, identified a reciprocal influence between his depressive symptoms and grief reaction. In applying the Inventory of Complicated Grief to ascertain grief reaction intensity to help the client discern between major depressive symptoms and grief reaction, the author found that the client (1) could not accept the loss of his wife, (2) had difficulty adjusting to life after his wife's death, and (3) faced a tense and distant relationship with his son. Such resulted in suicidal ideation and planning and feelings of loneliness, helplessness, hopelessness and incapability, which triggered major depression and a complicated grief reaction. Therefore, the author applied grief counseling to help the client accept the loss of his spouse, communicate his grief, overcome the difficult adjustment to life after his spouse's death, bid farewell to his wife, and establish new relationships. Such counseling gradually helped the client accept the inevitability of death and his wife's passing. To help the client establish new relationships under existing circumstances of negligible external support systems, the author encouraged the client to establish a new relationship with himself and integrate the old-age stage of life cycle naturally into his daily routine. Based on this care experience, we recommend psychiatric nurses assess cautiously the loss experience and grief reaction in elderly widowers under their care in order to provide timely grief counseling intervention to help the client pass quickly through the grieving phase and free him or her from the haze of depression.