運用理情行為治療協助一位思覺失調症合併強迫症狀個案之自我控制感重建的護理經驗

Nursing Experience With Reconstructing Self-Control Using Rational-Emotive Behavior Therapy on a Patient With Schizophrenia and Obsessive-Compulsive Symptoms

本文描述照顧一位思覺失調症合併強迫症狀患者的護理經驗。個案有被控制感、強迫性思考與行為等症狀。除此之外，個案表現出針對焦慮缺乏因應策略及改變痛苦的動機，在日間病房住院期間，無法進行高階復健工作訓練，導致難以回歸社會獨立生活。護理期間自2016年10月21日至2017年1月10日，以身體、情緒、智能、社會及靈性等五大層面對個案進行整體性評估，確立護理問題主要為：（一）思考過程紊亂；（二）無效性因應能力。護理過程以理情行為治療為基礎，進行被控制感及強迫症狀的因應策略，輔以放鬆技巧降低進行護理過程中的不適感。結果呈現個案可推翻非理性信念，並以理性的情緒及合適行為來面對壓力，更能在出現焦慮及疼痛感受時，應用放鬆技巧緩解不適。本文建議護理師可對相似個案在建立治療性關係時，即主動運用理情行為治療中非理性反駁之訓練，並佐以放鬆技巧之應用，可有效協助個案面對生活壓力事件。此護理經驗成果，亦提供給護理同仁臨床照護上之參考。 This case report describes a nursing experience caring for a patient with schizophrenia and obsessivecompulsive symptoms. This patient suffered from symptoms of being controlled, obsessive thoughts, and compulsive behaviors. In addition, the patient showed no interest in implementing strategies for dealing with anxiety, no motivation for changing this suffering, and an inability to receive a higher level of rehabilitative job training in daycare. These problems impeded this patient's reintegration into the community. Therefore, the authors employed a five-dimension assessment (physical, emotional, cognitive, social, and spiritual) in order to address the two major nursing problems. The period of nursing care was from October 21, 2016 to January 10, 2017. The two nursing problems addressed included: 1) altered thought processes and 2) ineffective coping. The author provided potentially helpful nursing processes based on the theory of Rational-Emotive Behavior Therapy in order to help the patient cope with symptoms, including being controlled and obsessive-compulsive behaviors. Meanwhile, a relaxation technique was applied to reduce the patient's feelings of discomfort during the nursing processes. As a result, the patient's coping skills to deal with symptoms of being controlled, obsession, and compulsion were improved through refutation of irrational beliefs. In addition to showing rational emotions and appropriate behavior to handle pressures, the patient was also able to apply the relaxation technique to relieve the discomfort from anxiety and pain as needed. This case report suggests that nurses may implement the irrational beliefs refutation training regimen under Rational-Emotive Behavior Therapy for similar cases at the beginning of nursing-patients relationships. Furthermore, providing relaxation techniques in the nursing process may assist patients to deal with stressful life events. The results of this nursing experience are expected to help nursing colleagues apply the above theory and skills with schizophrenia patients with obsessive-compulsive symptoms.