一位具有暴力行為的精神分裂病病患之護理經驗

Nursing Care Experience of a Violent Patient with Schizophrenia

本文係以環境治療及治療性人際關係為架構，照顧一位具暴力行為之精神分裂病患的護理經驗。在病患住院期間，護理人員對病患作身體、情緒、智能、社會及心靈上的整體性評估，發現有高危險性暴力行為、思考過程改變、社交互動障礙、個人因應能力失調、知覺感覺改變、不遵從等問題。藉由治療性人際關係技巧中，真實的、一致的、誠懇的、支持的、有計畫的態度及護理活動之運用，加上醫療組員的配合與努力，善用環境治療中之結構化、社會化、個別化等原則，提供生活討論會、病情討論會、低功能結構性團體活動、職能治療、娛樂治療等活動，使病患在住院期間病情改善，對疾病、情緒的認知處理、及調適能力漸漸增強，進而回歸家庭與社會生活。

This article deals with a nursing care experience of a violent patient with schizophrenia under the construct of milieu therapy and therapeutic interpersonal relationship. During the hospitalization, the patient was assessed by the primary nurse as having high potential violent risk, altered thinking process, disturbed social interaction, dysfunction of personal coping ability, perceptual change, and disobedience after a holistic physical, emotional, intellectual, social and spiritual assessments. By utilizing the technique of therapeutic interpersonal relationship, the real, consistent, sincere, supportive, and programmed attitudes and nursing aetivities were applied. The author also adopted the principles of the milieu therapy that include structural, socialization, and individualization in clinic practice. These principles were further provided in daily life discussion, disease panel discussion, low-level functional structured group activities, occupational therapies, and recreational therapies. The efforts contributed to the improvement of the patient's illness during the hospitalization. It also enhanced her insight and copying ability. Meanwhile, this did helps the patient back to her family and social life as well.