運用服藥結盟概念於一位躁鬱症重覆住院患者之護理經驗

A Nurse’s Experience Building Medical Alliances for a Repeatedly-Hospitalized Patient With Bipolar Disorder

本文主要描述一位躁鬱症患者，因服藥結盟不足，造成疾病復發而重覆入院之臨床護理經驗。護理期間為2009年2月2日至2009年4月7日，運用觀察及會談技巧進行整體性護理評估，歸納出個案主要護理問題有高危險性暴力、思考過程紊亂、服藥結盟不足等。針對服藥結盟不足，運用服藥結盟概念，擬定符合個案需求之個別性護理計畫，了解個案疾病史，對疾病與治療的看法，及藥物的矛盾情緒，建立合作之結盟關係，促使個案願意接受藥物治療並回歸社區。

This article reports on the experience of clinical nurses in treating a patient with bipolar disorder who was re-hospitalized following a relapse attributed to poor medical alliance. During the period of nursing care (February 2 to April 7 2009), observation and interviews employed to assess the patient resulted in the three nursing diagnoses of violence risk, disorganized thinking process, and poor medical alliance. With the goal of enhancing medical alliance, an individualized plan of nursing care designed to better understanding the patient’s illness history, illness and treatment attitudes, and feelings of ambivalence towards medicines was implemented in order to foster a closer nurse-patient relationship and enhance patient motivation to accept medical treatment to permit a return to a normal life as soon as possible.