協助一位精神分裂個案改善家庭關係之護理經驗——現實治療法之應用

Nursing Experience Helping a Client With Schizophrenia Improve Her Family Relationships: Application of Reality Therapy

現實治療法為改變個案行為之有效策略。本案例係以現實治療理論中四階段問話技巧，包括：需求（want）、行為（doing or direction）、評估（evaluation）及計畫（plan），即WDEP系統，為護理介入的治療性溝通工具，協助一位精神分裂病個案改善其與家庭成員的關係。護理期間為2010年10月21日至11月19日。筆者以現實治療法的架構及WDEP系統，引導個案探索內在需求，促使個案以客觀方式看待自己的問題，明瞭自己能做何努力。經由協助個案釐清本身的能力及優勢，並鼓勵有效的行動，個案與家人之關係逐步得到改善。本文藉由介紹現實治療法概念，輔以臨床實例的應用，可增進讀者對現實治療法的認識，並作為護理同仁在照顧個案時另一種溝通架構之參考。

Reality therapy has been demonstrated to be an effective strategy in achieving behavioral change. This case study used reality therapy as a therapeutic communication tool to help improve the family relationships of a client with schizophrenia. We used a four-tiered questioning technique to address, respectively, the aspects of ”want,” ”doing / direction,” ”evaluation” and ”plan” (WDEP). Nursing interventions were held between October 21st and November 19th, 2010. The authors used the reality therapy framework and WDEP system to guide the client to explore her inner needs, review problems objectively, and determine where efforts could be focused most effectively. Better appreciation of her abilities and strengths and encouragement of effective actions helped improve client relationships with her family members. This study introduced reality therapy and shared clinical experiences in order to help readers better understand reality therapy as an alternative framework of communication in nursing care.