哀傷輔導模式用於老年憂鬱患者之護理經驗

Nursing Experience Applying a Bereavement Counseling Model on an Elderly Patient With Depression

哀傷輔導模式是處理個案失落經驗的有效策略。 本案例是以沃登（Worden）哀傷輔導四個階段性介入，包括：接受失落的事實、經驗悲傷的痛苦、重新適應沒有逝者的新環境、將情緒活力重 新投注在其他關係上，作為護理介入的治療性溝通步驟，協助一位老年憂鬱患者完成悲傷任務， 重新生活。護理期間自民國104年12月14日至 105年2月3日止。筆者以哀傷輔導幫助個案體認喪親的事實、悲傷情感表達與支持、協助克服 喪親後再適應的障礙、與死者告別並建立新關係 之生活目標。最後個案可以體認事實的不可抗拒性，願意接受孫子已死去的事實，並重新接納自己及身邊原有的支持系統，改變過往因應哀傷的行為模式，將生活重心轉向新的期許和關係的再連結。建議護理人員面對老年憂鬱患者，除謹慎評估失落經驗及悲傷反應，予適當哀傷輔導介入，將有助老人度過悲傷任務。

Grief counseling is an effective treatment for those who have experienced a loss. In this case study, therapeutic communication was used as part of a nursing intervention to assist an elderly patient with depression to overcome grief and continue with life. The stage-based Four Tasks of Mourning proposed by William Worden were employed. These tasks include: (1) accepting the reality of the loss; (2) working through the pain of grief; (3) adjusting to a new environment without the deceased; and (4) focusing attention on other relationships. The nursing intervention occurred between December 14, 2015 and February 3, 2016. During this period, the author offered grief counseling to help the subject endure the loss of their kin, express their grief and pain, overcome difficulties in making adjustments, and move on from the loss by developing new life goals. The subject eventually acknowledged the irreversibility of what had happened and accepted the death through self-reacceptance and the support of friends and family. The patient was thus able to overcome his grief-induced behavior patterns, and rekindle his hopes for life and existing relationships. Therefore, the author recommends that nursing personnel assess carefully the reactions of elderly patients with depression to loss and provide adequate grief counseling that helps them fulfill the tasks of mourning.