運用認知行為治療於一位心因性暴食症患者之護理經驗

Treating Bulimia Nervosa: A Nurse’s Experience Using Cognitive Behavior Therapy

本文描述照顧一位初次到精神科求助的心因性暴食症患者之護理經驗。護理期間自97年4月21日到97年6月16日。藉由觀察、會談及病歷查閱蒐集資料，以五大層面評估，發現護理問題為：營養狀況改變—與不正常飲食型態有關、個人因應能力失調、身體心像紊亂。筆者採認知行為理論，分為三個不同階段提供照護措施。首先，以關懷的態度和個案建立良好護病關係，教導個案紀錄飲食日記且從中發現暴食的原因；次之，協助適當表達情緒與感受，並找出有關身體形象和體重的錯誤迷思；最終，提升患者的問題解決能力和因應技巧，以避免再復發。一個月後電話追蹤，其情緒穩定，未再出現暴食行為，體重也在自己滿意的範圍，同時個案也可持續運用認知行為技巧於生活中，亦可利用運動、找人陪伴，來取代不適當的代償行為。透過此報告能提供護理人員對心因性暴食症有更深的認識，亦可做為臨床照顧的參考。

This paper focused on the experience of the authors in providing nursing care to a patient with bulimia nervosa who sought psychiatric assistance upon her first episode. The nursing period spanned a period from April 21, 2008 to June 16, 2008. After primary diagnosis, relevant data was collected by observation, interview, and a review of medical records. The patient's disease was assessed from five dimensions. Care problems faced for this patient included: altered nutrition profile, abnormal eating patterns, ineffective individual coping, and body image disturbance. The authors adopted a three-stage nursing intervention based on cognitive behavior theory (CBT). First, a caring attitude was employed to establish a good nurse-patient relationship, after which the patient was instructed to maintain a diet diary, which could be used to help identify the underlying causes of her bulimia nervosa condition. Secondly, we assisted the patient to express her emotions and feelings in order to help her disentangle herself from unhealthy perceptions regarding body image and weight. Thirdly, we assisted the patient to develop critical problem-solving abilities and coping skills that would help avoid symptom recurrence. We followed up on patient progress by telephone for one month after treatment. The treatment had successfully stabilized her emotions and bulimia nervosa did not recur. Her body weight was kept within a satisfactory range. Furthermore, she applied cognitive behavior skills in daily life continuously, and she did exercise and kept company with an individual who helped reinforce appropriate behavior. It is hoped that this report can help nurses better understand bulimia nervosa and be used as a reference in clinical care.