以家庭為中心照護住院躁鬱症病人之轉變經歷

The Family Transition Experience: Family-Centered Hospitalization Care of Bipolar Disorder Patients

背景：躁鬱症病人及家屬因為對疾病認知、治療的態度不同，對衝突情境的看法及感受也不一樣，致影響病人的醫療方式及預後。本文護理人員轉換傳統以病人為中心的照護方式，將護理重點放在促進家庭成員互動關係、溝通模式及溝通歷程，以家庭為中心的照護應對家庭適應較好。目的：探討以「家庭為中心」之護理，躁鬱症病人家庭所發生之轉變經歷及照護者常用之因應策略技巧。方法：採質性研究之半結構性深度訪談法進行，分別與八個家庭進行各四次，每次約60-90分鐘會談，以內容分析法分析進行資料處理，歸類重要主題。結果：躁鬱症病人家庭之轉變經歷，可以歸納為「原來都是疾病惹的禍」、「家裡有愛」、「約定再出發」之轉變歷程，並增加家庭發展出正向互動的轉變。過程常使用「引導家庭成員對疾病現況之體驗」、「啟發家庭的潛在力量」及「動員家庭內外在資源」等因應策略技巧。結論／實務應用：基於以家庭為中心之護理理念，促進病人及家屬能有機會重新檢視個人優點及家庭資源、找尋解決問題之道，彼此能有效溝通，且可共同訂立家庭契約而得到治療效果。

Background: Differences in cognition and attitudes between bipolar disorder patients and their families frequently result in differences between the two in terms of opinions and perceptions on appropriate medical treatments and prognoses. Transforming patient-centered-care psychotherapy into an intervention that provides family-focused nursing, promotes interaction among family members, and changes communication styles may assist families to adapt and focus on pursuing the soundest medical treatment. Purpose: This qualitative study explores the healing process of family transition in terms of family-centered care for bipolar disorder patients and nursing strategy intervention.Methods: A psychiatric nurse with clinical experience used four 60-90 minute semi-structured, in-depth interviews to collect data from 8 families. The process was recorded and transcribed verbatim. Content analysis was used to analyze and categorize the major themes.Results: Results were generalized into three themes that addressed the interaction-in-transition between patients and their families. These themes were: ”All of the blame comes from the disease”, ”There is love in the family”, and ”Agreement to start over”. Nurses increased their positive interaction with the family by facilitating cognitive, emotional, and behavioral change in the family. The 3 nursing strategy interventions used in this study to promote family adaptation in this study were: (1) guiding family experiences of the disease situation; (2) inspiring the potential strength in the families; (3) mobilizing the internal and external resources of families.Conclusions/Implications for Practice: Nurses may help family healing by identifying family strengths and resources, looking for solutions to problems, transforming effective communicating style, and making family contracts.