照顧一位青少年網路遊戲成癮合併自殺的護理經驗

Nursing Experience of Caring for an Adolescent with Online Gaming Addiction and Suicidal Ideation

本文描述一位13歲青少年因偏差認知、人際互動障礙且沉迷手機遊戲後，家屬又缺乏照護技巧，導致個案日夜顛倒、輟學且合併自殺及暴力衝動行為之護理經驗。照護期間自2018年6月26日至2018年7月21日，藉由參與照護、實際觀察、病歷查閱、治療性會談及精神科五大層面評估，以傾聽、同理及友善接納的態度，主動與個案建立治療性人際關係，確立護理問題：一、潛在危險性暴力行為：自我傷害及傷害物品；二、無效性因應能力；三、社交互動障礙；四、照顧者知識不足；五、睡眠型態紊亂。運用教導因應法如：畫圖、撕紙等，轉移注意力並改善衝動行為；以行為修正法（Behavioral Modification）增強自我管理及控制技巧，引導家屬與個案共同製作「戰勝網路成癮小手冊」；以認知行為治療（Cognitive Behavioral Therapy, CBT）矯正偏差認知；以減少傷害療法（Harm Reduction Therapy, HRT）強化興趣增強信心，增加合宜的人際互動技巧，安排家族會議協助家屬共同介入，增強家屬照護技巧，進而改善個案面對壓力之因應方式，並促進正向親子關係。希望藉由此次的分享照護經驗，提供日後護理人員照護類似個案之參考。

This article describes the nursing experience of caring for a 13-year-old adolescent with sleep inversion and truancy, combined with suicidal ideation and violent impulsive behavior due to cognitive bias, impaired interpersonal functioning, addiction to mobile phone games, and lack of care skills in family members. During the period of care between June 26, 2018 to July 21, 2018, an attitude of listening, empathy, and amiable non-judgment was taken throughout participatory care, close observation, review of medical records, talk therapy, and five-level psychiatric assessment to proactively develop a therapeutic interpersonal relationship with the patient. The following nursing problems were established: (1) potentially dangerous violent behavior, involving self-harm and property damage, (2) ineffective coping and adaptative strategies, (3) impaired social interaction, (4) lack of knowledge in caregivers, and (5) sleep disorder. The patient was instructed in coping methods such as drawing and paper shredding, which were used as a means of distraction and to improve impulsive behavior, and behavioral modification was used to enhance self-management and self-control skills. The patient and family members were guided to collaborate on the creation of a ＂handbook for overcoming online addiction,＂ and cognitive behavioral therapy (CBT) was used to correct the patients' cognitive bias. Harm reduction therapy (HRT) was used to strengthen interest, enhance confidence, and improve the appropriate interpersonal skills. Workshops were conducted to assist intervention by family members and enhance their caregiving skills in order to improve the patients' stress management strategies, thereby promoting positive parent-child relationships. This case report provides a resource that could help nursing personnel in caring for similar cases in the future.