用行為治療於一位輕度智能不足合併焦慮之護理經驗

Nursing Experience of Using Behavior Modification for Caring a Patient with Mild Intellectual Disability Combining with Anxious Mood

本文闡述一位22歲輕度智能不足合併有焦慮之患者，於社區中屢次出現偷竊行為經家中看護發現此狀態企圖報警時，因個案衝動控制不佳，發生激烈肢體衝突，於家屬報警後經轉送急性病房，住院期間因菸癮狀況存伴隨焦慮情緒，會至護理站表露身體不適症狀外，其因應採反覆領用尼古丁口嚼錠作為減緩焦慮方式，但改善效果有限，故引發作者介入行為改變技術動機。照護期間自2022年10月12日至11月04日，於建立良好治療性人際關係後，藉會談、病歷回溯及整體性護理評估工具收集資料，歸納護理問題為：焦慮、因應能力失常及體重過重。由跨團隊合作照護精神，引導思辨個案自覺焦慮行為感受，介入三週結構式行為改變技術後，並由行為觀察趨勢圖追蹤成效，亦發現個案可有良好焦慮因應技巧展現，使減少不合宜行為，最終銜接後續日間慢性復健機構。希冀由此經驗可做為精神衛生護理師處遇相似個案之照護參酌。

This article reported the case of a 22-year-old male patient with mild intellectual disability who presented with significant anxiety symptoms. He had committed theft several times and was discovered by his father’s caregiver. When she attempted to contact the police, the patient attacked and injured her. Due to poor impulse control and violent behavior, he was admitted to the psychiatric acute ward. During hospitalization, the patient frequently reported various physical discomforts and repeatedly approached the nursing station to express anxiety. His symptoms were considered to be related to nicotine withdrawal and worry about the legal consequences of his thefts. Although he used nicotine chewing gum five to six times per day as a coping strategy, his anxiety improved only minimally.
To strengthen his anxiety-coping abilities, a behavioral modification plan was implemented. From October 12, 2022, to November 4, 2022, the care team established a strong therapeutic relationship with the patient, collected information through interviews, reviewed medical records, and conducted a comprehensive assessment across five major domains. The primary nursing problems identified were anxiety, ineffective coping, and overweight. Following principles of interprofessional collaborative practice, the patient was guided to connect his physical complaints with underlying emotional responses. After three weeks of structured behavioral modification, he demonstrated improved coping strategies for managing anxiety. A downward trend in his daily use of nicotine chewing gum was also recorded. The patient was subsequently transferred to a psychiatric day-care ward. This experience may serve as a valuable reference for psychiatric nurses caring for similar cases.