照護一位反覆自殺憂鬱症病人之護理經驗

The Nursing Experience of Caring for a Depression Patients with Repeated Suicide Attempt Colostomy

本篇是照護一位24歲男性，因親子溝通家庭互動障礙及工作問題等無法因應之生活壓力事件，導致憂鬱症復發，並服用大量安眠藥自殺，於精神科急性病房住院治療的護理經驗。護理期間自2013年8月28日至9月20日，筆者藉由實際觀察、會談、傾聽及精神科五大層面進行整體性評估，發現主要健康問題為危險性自我傷害、因應能力失調和低自尊。筆者考量病人具強烈負向思考，對內心想法及感受多悶於心中，少向他人表達，且人際互動技巧不純熟，故以傾聽、同理、關懷、真誠的態度，協助病人正、負向感受的表達，學習有效人際溝通，鼓勵與支持病人，促進正向思考模式及肯定自我，增強壓力情境的因應能力，進而改善家庭互動關係。護理照護期間，觀察病人反覆以自殺方式處理壓力與情緒，因此教導病人自我情緒管理，提昇認知功能，加強自我調適技巧，並引導建立家庭成員之間有效的溝通方式及支持系統，提供符合病人需求之社會資源，透過多次會談治療修正其負向思考模式，改善認知上的偏差問題，進而預防再次自殺行為。建議在照護出現反覆自殺行為的憂鬱症病人，可提升其壓力因應技巧，促進自我表達與建立正向思考模式，達到預防自殺行為之目的。

This article presented a nursing experience of caring a 24-year-old male depressive patient admitted to our acute psychiatric ward due to difficulties in coping with life stress events which caused recurrence of depression and attempted suicide by taking hypnotic drugs. The life stress events included intrafamilial conflict and deficits in interaction and communication with his family as well as frustration from work etc. The authors collected data through observation, in-depth interview and listening between August 28th and September 20th, 2012. Three major nursing problems were identified: risky self-harm behavior; ineffective coping strategy, and low self-esteem. Because of the considerations of the patient’s characters such as negative thought, no dialogue of innermost feelings with others, impaired interpersonal relationships and skills, we enabled us to establish therapeutic alliance with empathy, true and warm attitude, and improve the patient’s expression of positive emotion and suppression of negative emotion, learn effective communication, provide better support and enhance positive thinking process, and coping skills of stress management. Then rehearsals of effective communication between this patient and family were practiced to enhance family interaction and relationships. During nursing care period, the patient’s pattern of using repeated suicide to handle stress and emotional distress was found. The authors used cognitive re-processing to correct the patient’s negative thought, enhance self-adaptation skills, guide the patient and families to build up effective communication and supportive system, and provide necessary social resources. Through many interviews, cognitive distortion was decreased to eliminate suicide. This care promoted this patient’s mental health, stress management skills, self-expression and positive thinking and eventually prevented suicidal behavior.