運用理情行為治療模式於物質使用誘發精神疾病個案之護理經驗

A nursing experience using the rational-emotional therapy model for substance-induced psychosis

研究指出長期使用安非他命而有精神症狀的個案中，有22%會轉變成思覺失調症，而聽幻覺是最常見的精神症狀，它會影響到個人的社交和職業功能。本文描述一位過去因使用中樞神經興奮劑（安非他命）而出現聽幻覺，進而診斷為思覺失調症個案之護理經驗。護理期間自2022年2月17日至3月14日，照護過程個案常因精神症狀干擾及情緒控制能力差而影響人際相處與社交互動，藉由觀察、會談及病歷查閱等方式蒐集資料，並以五大層面整體性評估，發現有感覺及知覺紊亂與情緒管理能力不足的護理問題。筆者採用Ellis提出的理情行為治療A-B-C理論模式，提供個別性照護。首先以關懷態度和個案建立良好護病關係，於會談中介紹並運用自我信念檢核，由事件中找到非理性信念，討論駁斥與干預信念的方法，產生新的理性信念。最終個案能運用正向因應行為技巧於生活中，取代不適當的情緒及行為表現。

Research indicates that 22% of individuals experiencing amphetamine-induced psychosis eventually transition to a diagnosis of schizophrenia, with auditory hallucinations serving as a primary driver of social and occupational dysfunction. This article details the nursing care of a patient diagnosed with schizophrenia and stimulant-related auditory hallucinations between February and March 2022, focusing on the resulting disturbances in sensory perception and emotional regulation. Data were collected via clinical observation, interviews, and medical record reviews, utilizing a five-level holistic assessment to identify key nursing challenges. To address these, the author applied Ellis’s A-B-C model of Rational Emotive Behavior Therapy (REBT) within a foundation of a therapeutic nurse-patient relationship. By guiding the patient to identify activating events (A), recognize the resulting irrational beliefs (B), and dispute these misconceptions (C), the intervention facilitated the development of rational beliefs and positive coping skills. This structured approach ultimately enabled the client to replace maladaptive emotional outbursts with appropriate behavioral expressions and improved interpersonal interactions.