環境治療於慢性精神分裂病人漫遊的護理經驗

Nursing Experience: Environment Therapy on the Wandering of a Chronic Schizophrenia Patient

本文探討一位慢性精神分裂病人的漫遊問題，護理期間由2010年2月1日至4月29日，藉由身體評估、會談、直接照護及觀察家庭互動情形，並運用身體、情緒、智能/認知、社會及靈性等五大層面整體性評估為架構來收集資料，確立個案有漫遊和定向感障礙的 問題，護理措施以環境治療為主軸，藉由增強個案對環境定向感的 認知，減少其漫遊時對空間失序的障礙，而使其能於特定範圍內走動，降低意外傷害和與人衝突的機率，和減少漫遊的時間，以達成護理目標。從此護理經驗中印證文獻所提的環境療法，然而，礙於人力上的限制，無法針對個案的漫遊行為成立散步團體，或實施運動計畫，建議日後單位可群集所有漫遊的病人，成立每日散步或運動 團體，以降低慢性精神分裂個案漫遊的時間，期許此篇護理經驗能 喚起精神科護理人員重視慢性精神分裂病人的漫遊問題。

The purpose of this paper is to explore options for addressing the problem of wandering in chronic schizophrenia patients. The author collected data by using physical assessment, conversation, directing care, and observing family dynamics. The data was analyzed using five different aspects - physical, emotional, intellective /cognitive, social and spiritual - as the comprehensive assessment framework to identify the case’s problems of wandering and orientation disturbance during the nursing period from February 1 to April 29, 2010. Environment therapy is the core nursing intervention used for enhancing the cognition of the patient’s awareness of his environment in order to reduce disorientation during wandering, shorten the length of time spent wandering, and decrease the rate of accidents and fighting with others while walking in a certain area. The results of this nursing experience verify the effectiveness of environment therapy reported in the literature and suggest that development of daily walking or exercising groups for chronic schizophrenia patients with wandering will shorten wandering time. However, due to limited manpower, the study could not encompass the development of a walking group or exercise program for patients with wandering. It is expected that this nursing experience will encourage psychiatric nurses to value the wandering problem of chronic schizophrenia patients.