運用認知行為治療於一位重覆自殺青少年患者之護理經驗

Nursing Experience Using Cognitive Behavior Therapy on a Multiple Suicide Adolescent Patient

本篇個案報告是運用認知行為治療於一位重覆自殺之青少年患者的護理過程，護理期間於96年1月25日至96年3月25日。照護期間，以觀察、會談和個案及家屬討論的方式來收集資料，並運用身體、情緒、智能、社會及靈性五大層面護理評估工具，以確認個案主要的護理問題為(1)潛在危險性自我傷害；(2)社交互動障礙；(3)睡眠型態紊亂。住院期間，運用認知行為治療，來矯正個案偏差的認知，以降低其自殺意念及改善睡眠障礙的問題；此外，運用角色扮演的技巧，來提供相關的社交技巧訓練，以增進個案與他人互動之能力。經過八週的照護，出院前個案可對負向自動化思考提出有效的因應技巧，且主動參與團體治療活動；出院後於門診訪視及電訪追蹤，家屬及老師表示個案現在情緒穩定，未再有自殺的行為出現，可參與學校同儕社團，且能有正常的生活作息。

This case report described a nursing process that employed cognitive behavior therapy in the care of a repeated suicide adolescent patient between January 25 and March 25, 2007. Data collection was done through observations, interviews and discussions conducted concurrently with the patient and his family. The patient was evaluated physically, emotionally, intellectually, socially and spiritually. Major nursing problems identified included: (1) potential suicide risk, (2) social interaction disturbance, and (3) sleep pattern disturbance. During hospitalization, cognitive behavior therapy was employed to correct distortions in patient cognition, reduce suicidal ideations and improve sleep quality. Role-playing was also employed to deliver social skills training, which enhanced the ability of the patient to interact with others. After eight weeks and prior to discharge, the patient was able to use effective coping skills to face his negative-automatic thinking and actively participate in group therapy. After discharge, the author tracked patient progress by visiting the OPD and through communications over the telephone. His family and teacher described the patient as having a stable mood, no longer attempting suicide and being able to join clubs on campus and live a a normal daily life.