運用自我管理策略於一位亞斯伯格症病人之照護經驗

The Use of Self-Management Strategies in the Nursing Care of a Patient with Asperger’s Syndrome

本文乃在探討一位青少年亞斯伯格症個案，因行為、情緒及社交障礙等問題反覆出入院，需求未獲滿足時出現干擾、暴力及不遵從治療等情形，導致臨床照護困擾與壓力。運用整體性護理評估發現個案有：「危險性對他人的暴力行為」、「無效性因應能力」、「不遵從」、「社交互動障礙」等健康問題，護理期間筆者運用『自我管理策略』提升個案人際關係及獨立性並減少破壞性行為；過程中配合結構化處置及認知行為治療來改善個案之負向想法及行為，與個案建立良好護病關係，針對個案問題行為擬定個別化、具體明確且結構化之護理措施，配合個案認知能力、興趣、學習動機與意願，再輔以隨機教育滿足其需求，改善個案問題行為，藉此照護經驗與護理人員分享。

This article presents the case of a teenager with Asperger's syndrome, who was frequently admitted to and discharged from psychiatric wards because of his behavioral and emotional problems and poor social relationships. Since the patient tended to disturb or be violent toward others, and not comply with treatment when his perceived needs were not being fulfilled by professionals, it was very difficult and stressful to care for him. We used a holistic nursing assessment and found that the patient's problems were: risk for other-directed violence, ineffective coping, noncompliance, and impaired social interaction. We used self-management strategies to improve the patient's interpersonal relationships and independence and to reduce his violent behavior. In the process, we used structured interventions and cognitive behavioral therapy to improve the patient's negative thoughts and behaviors. We also established rapport with the patient, and made individualized, clear, and structured nursing intervention for his specific problems. This work was aided by the cognitive ability, interest, motivation to learn, and willingness of the patient, and supplemented by as-needed education to improve his behavioral problems. Through the presentation of this case report, we hope to share our experiences in caring for this Asperger's patient with other nurses.