運用鏡子影像回饋改善慢性思覺失調症病人視幻覺之護理經驗

Nursing Experience of Using Mirror Visual Feedback for a Schizophrenia Patient With Visual Hallucinations

本案例是以鏡子影像回饋技巧為主的階段性輔導介入，協助一位長期受視幻覺干擾的慢性精神科住院病人，降低視幻覺干擾頻率，提升生活品質。護理期間自2015年5月15日至10月19日止， 筆者運用會談、觀察及五大層面評估等方式收集資料，歸納個案主要健康問題有：感覺及知覺紊亂（ 幻覺）、自我照顧能力缺失：沐浴及穿衣及照顧者角色緊張等。在改善視幻覺護理措施部份， 筆者先與個案共同討論治療計畫，擬定幻覺記錄表格，教導幻覺轉移技巧及合宜的因應方式，得以重新建立個案的自信心與希望。再運用大腦可塑性及鏡子影像回饋的理論及技巧，以強化視覺刺激競爭神經傳導系統，降低幻覺出現頻率。再者合併行為契約的執行、重新教導身體的清潔流程及方式，改善自我照顧能力缺失問題。最後， 在照顧者角色緊張部分，筆者經由與主要照顧者的多次會談，以主動關懷、同理心、鼓勵表達內心感受、耐心傾聽及提供相關醫療訊息，協助個案和主要照顧者能共同面對問題，促使個案自理日常生活及降低主要照顧者的壓力負荷，以積極、正向地共同面對未來。

The aim of this paper was to describe the nursing application of mirror visual feedback in a patient suffering from long-term visual hallucinations. The intervention period was from May 15th to October 19th, 2015. Using the five facets of psychiatric nursing assessment, several health problems were observed, including disturbed sensory perceptions (prominent visual hallucinations) and poor self-care (e.g. limited abilities to self-bathe and put on clothing). Furthermore, “caregiver role strain” due to the related intense care burden was noted. After building up a therapeutic interpersonal relationship, the technique of brain plasticity and mirror visual feedback were performed using multiple nursing care methods in order to help the patient suppress her visual hallucinations by enhancing a different visual stimulus. We also taught her how to cope with visual hallucinations in a proper manner. The frequency and content of visual hallucinations were recorded to evaluate the effects of management. The therapeutic plan was formulated together with the patient in order to boost her self-confidence, and a behavior contract was implemented in order to improve her personal hygiene. In addition, psychoeducation on disease-related topics was provided to the patient’s family, and they were encouraged to attend relevant therapeutic activities. As a result, her family became less passive and negative and more engaged in and positive about her future. The crisis of “caregiver role strain” was successfully resolved. The current experience is hoped to serve as a model for enhancing communication and cooperation between family and staff in similar medical settings.