賦權策略介入改善一位思覺失調症病患之服藥依從性

Evidence-Based Nursing: Using Empowerment Strategies to Improve Medication Nonadherence in Patients with Schizophrenia

本文描述一位思覺失調症個案，因缺乏病識感，持續受到聽幻覺干擾，導致服藥不規則，造成反覆住院。筆者透過五大層面評估其護理問題，針對知識缺失／對疾病、藥物相關認知不足有關之健康問題，做實證護理之進一步探討。運用實證護理5A步驟，針對「賦權式疾病管理是否可改善本院住院思覺失調症患者的藥物依從性？」提出臨床問題；於Cochrane Library、PubMed、CINAHL及華藝線上圖書館，等資料庫進行搜尋，使用PICO關鍵字以Mesh及相似同義字進行檢索，並限制十年內文獻；經篩選後，最終選取一篇系統性文獻回顧進入評讀，並設計個別化之認識我的疾病與藥物計畫，透過動機式晤談與認知行為技巧進行介入。結果顯示，賦權式疾病管理介入課程具改善個案服藥依從性之潛力；介入前用藥配合度量表填答不完整，僅能作描述性分析，介入後分數為2分，較介入前實得分數3分呈下降趨勢。然而，照護過程中仍面臨若干限制與困難，個案曾出現藏匿藥物之行為，需透過藥物磨粉與督導服藥等方式，以確保治療順利執行，致護病關係建立過程一度趨於緊張，此外，家屬未共同參與賦權式疾病管理介入課程，亦構成本次介入之限制。於個案出院後追蹤期間，已能主動表達規則服藥之意願，進一步支持賦權策略有助於提升疾病管理能力與治療依從性。

This article reports a case of schizophrenia characterized by poor insight and persistent auditory hallucinations, leading to irregular medication use and recurrent hospitalizations. Nursing problems were assessed across five domains, with this paper focusing on health issues related to knowledge deficits regarding the illness and medications using an evidence-based nursing approach. Following the 5A steps of evidence-based nursing, the clinical question“Does empowerment-based disease management improve medication adherence in hospitalized patients with schizophrenia?＂was developed. A literature search was conducted in the Cochrane Library, PubMed, CINAHL, and Airiti Library using PICO-based keywords, limited to studies published within the past ten years. One systematic review was selected for appraisal. An individualized disease and medication education program was then implemented using motivational interviewing and cognitive-behavioral techniques. The results suggest that the empowerment-based disease management intervention has the potential to improve medication adherence. The medication adherence scale was incompletely completed at baseline; therefore, the analysis was limited to descriptive findings. The postintervention score decreased to 2 from a preintervention observed score of 3, indicating an improving trend. Despite challenges during the care process, including medication hoarding and limited family participation, the patient expressed willingness to take medication regularly during post-discharge follow-up, supporting the potential value of empowerment strategies in enhancing disease management and treatment adherence.