運用賦權於一位慢性思覺失調症病人照護

Using Model of Empowerment to Care for a Chronic Schizophrenia Patient

本文主要描述一位慢性思覺失調症病人，因疾病慢性化，導致個人衛生及社交互動差，且因疾病汙名，使其對自我多負向之評價，而顯低自尊。筆者於 2015 年7 月 4 日至 2016 年 1 月 15 日照護期間，予個別會談、觀察及運用五大層面整體性評估，發現病人有營養不均衡：多於身體需要/ 攝取量超過代謝需要量；沐浴衛生自我照顧能力缺失/ 缺乏動機；社交互動障礙/ 自我概念紊亂、缺乏社交技巧；長期性低自尊/ 肥胖、長期罹病、疾病恥辱感等護理問題，運用賦權模式，採主動關懷，以真誠及同理的態度，與病人建立治療性人際關係，並運用有效會談技巧，鼓勵、支持病人採用有效的因應策略，引導病人自我覺醒，自我作決策，使其發現自己的能力，增加自我控制力，進而改善體重、個人衛生、社交、自尊等問題，再藉由庇護性工場的復健，維持病人最高功能和獨立性。期望藉由此照護經驗能提供日後照護此類病人之參考。

This article describes a chronic psychosis disease patient with chronic illness resulting in a poor personal hygiene and social interaction. The illness further led to negative self-evaluation, and poor self-esteem.
During the period of hospitalization from July 4, 2015 to January 15 2016,the author conducted individual interviews by using the five levels of integrity psychiatric assessment. Though the whole course of observation, the patient revealed four major problems: 1. nutrition: overeating/poor metabolism; 2. poor ability of personal hygiene/lack of motivation; 3. social interaction obstacle/selfconcept confusion, lack of social skills; 4. Long-term poor self-esteem/ obesity,long-term morbidity, and disease stigma.
During the period of hospitalization, author used the model of empowerment,as well as caring, empathy and a sincere attitude, to establish a therapeutic relationship with the patient and used effective interview skills to encourage and support the patient to choose effective coping strategies. Patients must guide themselves to have self-awareness, make their own decisions and strengthen the ability of self-control and empowerment in relation to weight, hygiene, social interaction, self-esteem and other issues.
Throughout rehabilitation, the patient should maintain the highest patient function and develop independence. The description provided here can serve reference for future patient care.