運用行為治療於一位青少年思覺失調症合併強迫行為個案之護理經驗

Applying Behavioral Therapy in Nursing Care for a Adolescents Patients with Schizophrenia and Obsessive-Compulsive Symptoms

本文主要描述運用行為治療改善一位青少年思覺失調症合併強迫行為個案之護理經驗。個案因強迫行為而影響生活品質，導致自我清潔功能缺乏且人際互動出現障礙等問題。護理期間為2020年9月16日至11月6日，筆者藉由觀察、會談等技巧收集，並運用身體、情緒、智能、社會及靈性五大層面評估以確立護理問題，歸納出個案主要的健康問題有自我照顧能力缺失:沐浴及過度洗手、無效性因應能力及社交互動障礙等護理問題。筆者藉由建立穩定性的治療關係之後並與個案討論，過程有意願嘗試改善自身的健康護理問題，經個案同意下與醫療團隊討論訂定個別性行為契約的目標及內容，藉由循序漸進的方式，讓個案可慢慢接受並學習控制自己的行為，並進而改善因強迫行為而引起的情緒困擾及壓力，後續更教導社交技巧增進人際互動能力，隨著個案漸漸與病友間互動頻率增加，互動自信心也逐漸增強，不再獨來獨往。由此可知，思覺失調症患者合併強迫行為導致清潔功能缺失及社交互動障礙等問題是可經由行為治療及訓練進而改善的，期盼藉由此個案經驗分享，提供護理人員作為照護此類個案日後之參考。

This case report describes a nursing experience caring for a Adolescents patient with Schizophrenia and Obsessive-Compulsive Symptoms. The patient having been affected by Obsessive-Compulsive Symptoms would dramatically affect his quality of life, for instance, self-care deficit, and impaired social interaction. The care period was from September 16 to November 6, 2020. Data collection through observations, interviews and psychiatric five-dimensional global assessment. three majors nursing problems were identified included:1. self-care deficit 2. Coping ineffective 3. Social interaction impaired.After establishing a steady therapeutic relationship, And discussing with the case, try to improve his health care problems. The medical team and patient have worked together to conduct behavioral therapy, Step-by-step approach for learned to control his behaviors and emotional disturbance Caused by Obsessive-Compulsive Behavior. Follow-up teaching social skills and improve interpersonal skills. Continued to increase interaction between the case and other patients, the self-confidence in the interaction gradually increases and no longer alone. In conclusion, The problems of Schizophrenia patients with Obsessive-Compulsive Symptoms leading to Self-care deficit and Social interaction impaired.can be improved by Behavioral Therapy and training. It is hoped that this treatment experience could become a helpful reference for future cases.