照護一位缺乏病識感的思覺失調症病人之護理經驗

The Experience of Nursing A Schizophrenic Patient with No Intellectual Insight

本篇個案為缺乏病識感、未規則服藥的思覺失調症病人，曾於2010年7月4日因課業壓力大， 出現疑似精神症狀（聽幻覺、身體被控制）， 入院服藥一次，家屬無法接受個案罹患「精神病」，當天即辦理出院手續。此次家屬發現個案出現失眠、言談與現實不符，雖於門診追蹤，但返家後未規則服藥導致行為更紊亂而住院。照護期間為2015年01月06日至2015年02月03日，藉由實際觀察、會談、病歷回溯及運用五層面整體性護理評估的方式收集資料，發現個案健康問題有睡眠型態紊亂、焦慮、思想過程改變、社交互動障礙，知識缺失：疾病、居家照護等問題。透過與個案建立治療性人際關係，利用視覺焦慮自評量表（VAS）評估焦慮指數，培養覺察自身問題的能力，共同討論有效緩解焦慮方法，如：轉移、唱歌，鼓勵於焦慮當下實際運用；引導於團體活動時覺察自己人際互動狀況，反覆練習社交技巧，改善社交互動障礙；利用此時此刻溝通技巧，討論真實人事物，加強現實感及病識感，安排家屬座談會，使家屬共同參與照護計畫。針對照顧此類個案護理，建議透過了解並同理個案與家屬治療態度，澄清對疾病與服藥的烙印，建立病識感及強化規則服藥動機，避免再次發病及功能退化。

The schizophrenia patient whose case has been presented in this report had no intellectual insight and exhibited poor medical compliance. She was hospitalized on July 4, 2010,to address problems owing to academic pressure, but was suspected to have mental symptoms such as hallucination and somatic delusion. On account of the family members’ denial of the diagnosis of a mental disorder, they discharged the patient the same day. Later, the family members observed that the patient suffered from insomnia and made false comments on reality. Though under clinical follow-ups, she was hospitalized again because of the behavioral disorder caused by poor medical compliance. The patient’s care treatment began from January 6, 2015, and ended on February 3, 2015.Through actual observations, interviews, medical history, and assessments of the five dimensionsof schizophrenia, the patient was found to have a sleeping disorder, anxiety, altered thought processes, social interaction impairment, and knowledge deficit (regarding diseases, home care, etc.).With the establishment of therapeutic interpersonal relationships and discussion of effective anxiety releasing methods, such as focus transference and singing, the patient was encouraged to apply the visual analogue scale to assess anxiety to aid self-awareness of interactions with others. This aimed to help her tackle problems while interacting with groups, practicing social skills, and further improving social communication. By exploiting the communication skills and discussing present people and matters, the patient’s sense of reality and insight could be reinforced. Additionally, colloquia were held to involve the family members in the care treatment projects. The following suggestions are made for this case: it is important to sympathize with and understandthe bias of the patient and the family members against mental illnesses, clarify the disease, challenge the stereotype of taking medication to establish insight in the patient’, and enhance the motive of medication compliance in order to avoid relapse and functional degradation.