運用動機式晤談，提升情感性思覺失調病人遵囑服藥護理經驗

Nursing Experience Using Motivational Interviewing to Increase Medication Adherence in a Patient With Schizoaffective Disorder

本文為照顧一位不遵囑服藥之情感性思覺失調病人的護理經驗。病人長期居住於康復之家，因不遵從服藥，導致症狀明顯。住院後，拒絕服用口服藥，且對命令式幻聽症狀因應能力有限，出現自傷行為。筆者於2021年4月7日至5月3日執行護理照顧，期間藉由實際觀察、深度會談、病歷回顧等方式收集病人相關資料，並以五大層面呈現護理評估內容。同時藉由同理、傾聽、關懷的態度，建立信任的治療性人際關係，透過動機式晤談澄清病人不願服藥的脈絡，連結人生的目標與價值，透過強化病人的服藥動機，共同擬定個別性的護理計畫，並在規則服藥之下，病人逐漸降低幻聽干擾與自傷情形，病情穩定後出院返回康復之家居住，定期醫院門診追蹤。

This article describes an experience providing care for non-adherence to medication in a patient with schizoaffective disorder. The patient, a long-term resident of a rehabilitation home, was experiencing auditory hallucination symptoms related to his non-adherence to medication. After being hospitalized, he refused to take oral medications, and had limited ability to effectively deal with the command auditory hallucinations, leading to his self-harm behavior. The nursing period was from April 7th to May 3rd, 2021. Data were collected using observation, in-depth interviews, and a medical history review. The nursing assessment was conducted using the five dimensions of nursing assessment. The authors used empathy, listening, and caring attitudes to establish a trusting and therapeutic interpersonal relationship with the patient. A motivational interview approach was employed to strengthen motivation to take medication, guide and link the value of personal life, and jointly draw up a patient-centered plan to establish rules to which the patient would be able to adhere. Subsequently, the patient achieved reduced interference from auditory hallucinations and close adherence to his medication protocol and attended follow-up appointments regularly in the outpatient department after discharge.