運用正念訓練於思覺失調症患者之護理經驗

Nursing Experience of Applying Mindfulness Training on a Patient with Schizophrenia

本文主要探討運用正念訓練於思覺失調症合併焦慮之個案護理經驗。因個案易感焦慮，開始接受復健性治療工作（以下簡稱治工）後，焦慮加劇，甚至有負面想法，造成病情不穩。護理期間於2020年4月10至6月30日。照護期間以會談、觀察及病歷查閱等方式收集資料，護理過程中以友善接納的態度與個案建立良好護病關係，並運用焦慮概念為分析架構（包含：1.有莫名地威脅感、2.主觀不愉快的心理感受、3.會導致行為、情感、生理、認知的改變），確認個案主要護理問題為無法有效解決及面對多重壓力情境的焦慮。筆者運用傾聽、同理等方式來幫助個案了解引發焦慮的原因；個別性教導個案運用正念訓練法，將注意力從引發焦慮的環境或事件中，轉而全心全意關注自身，並藉由停一停、呼吸覺察及正念行走三個訓練方法轉移注意力以緩解焦慮。過程持續追蹤三個月，結果可有效降低焦慮程度，亦減少負向思考模式。在思覺失調症患者病程中，焦慮容易被忽略或低估，建議臨床護理人員若能及早發現並協助，可降低因焦慮引發的身心不適情況，更能避免導致病情不穩。期待能藉由此護理經驗的分享，提供作為照護此類個案之參考。

This study reports a psychiatric day care patient with schizophrenia and anxiety who received mindfulness training. We found that the patient’s anxiety levels elevated and his negative thoughts caused instability after rehabilitation training. The nursing care was provided from April 10, 2020 to June 30, 2020. Data collection was acquired from interviews, observations and medical record review. We established mutual trust with the patient through friendliness and acceptance. A conceptual analysis of anxiety was applied (1. Sense of inexplicable threat, 2. Subjectively unpleasant feelings, 3. Causes behavioral, emotional, physical, cognitive changes). We identified that the major nursing problem of the patient was unresolved anxiety when encountered multiple stressful situations. Listening and empathizing helped the patient understand his causes of anxiety. During the nursing process, the patient was educated to use mindfulness skills, shift anxiety and focus on himself wholeheartedly. Mindfulness training included stopping, breath awareness and mindful walking. Together, these methods assisted the patient in relieving his anxiety levels. The process continued for three months. The results of this nursing experience suggest patients should use mindfulness training to reduce their level of anxiety and negative thoughts. Anxiety is the most ignored or underestimated factor in treating patients with schizophrenia. This study suggests that early detection and assistance by clinical nursing staffs can reduce anxiety-induced physical and psychological discomfort. This nursing experience will be a helpful reference for future cases.