一位思覺失調症患者提供自主服藥訓練之照護經驗

The Nursing Experience of a Schizophrenic Patient After Training for Self-Administration of Medication

本文描述於青少年期早期發病，服藥順從性差，導致在14年內重複住院12次之思覺失調症個案的照護經驗，護理期間為2016年2月1日至2016年3月15日，期間筆者採身體、情緒、智能、社會、靈性五大層面之整體性護理評估收集資料，發現個案主要健康問題包括對他人潛在性的暴力行為、知覺感覺變異、服藥缺乏自主性。故筆者在護理過程中以真誠、關懷、接納、尊重的態度與之建立治療性人際關係。利用個別性藥卡讓個案了解藥物作用、副作用、劑量、時間、途徑使用，以收集點數正向鼓勵個案，進一步訓練排藥計畫，舉辦藥物團體衛教，引導個案瞭解規則服藥後可以控制精神症狀，建立個案疾病治療的正確觀念，減少幻聽頻率，使用合宜因應技巧阻斷幻聽干擾，教導情緒自我控制之重要性減少與家人、病友暴力衝突，完成了「遵從醫囑服藥」的共同目標。進而回歸家庭與社會生活，成功返回日間病房持續治療。

This paper describes the nursing experience of an early-onset schizophrenic patient who had poor drug adherence and was hospitalized 12 times in seven years. The nursing period was from February 1 to March 15, 2016. During this period, data was collected from holistic nursing assessments with regard to the physical, emotional, intellectual, social, and spiritual aspects of the patient. Findings identified major health problems in the patient, including potential violent behavior, perceptional changes, and lack of autonomy in taking medication. Given the circumstances, the author showed sincerity, care, acceptance, and respect toward the patient during the nursing period and established a therapeutic interpersonal relationship with her. An individualized medication card was used to show the drug effects, adverse events, and dosage of the medications, as well as its administration time and methods. The purposes were to encourage the patient, train her in medication planning, offer her health education organized by medication groups, and offer guidance to help her understand that drug adherence will help control psychiatric symptoms and signs. Nursing care was successful in establishing the patient's positive perception toward therapy, reducing the frequency of auditory hallucination, blocking out the interference of auditory hallucination using appropriate response skills, and teaching the patient the importance of emotional self-control in reducing violent clashes with family members. Together, the common goal of “taking medication according to physiciane's instructions” was achieved. The patient was able to return to her family and social life and was transferred back to a day-care ward for continuing treatment.