照護一位思覺失調病人的照護經驗

Nursing Experience of Caring for a Patient with Schizophrenia

本文描述照護一名思覺失調症病人，因疾病認知不足及不遵從服藥而反覆入院的照護理驗，護理期間為2023年12月30日至2024年1月29日，透過直接照護、會談觀察及病歷查閱蒐集資料，運用身體、心理、智能、社會及靈性五大面向進行整體性護理評估，經分析後歸納有感覺及知覺變異、知識缺失及社交互動障礙等三項護理問題。護理措施採取教導病人運用卡片記錄症狀及藥物作用，並對症狀發生時的因應技巧，提升疾病認知及加強訓練辨別現實情境與精神症狀的區分，另外藉由團體活動學習社交技巧，透過反覆練習以增進病人自我肯定與期待，最終達到病人順利出院且按時服藥並獲得良好控制。考慮到病人父母年紀漸增，擔心病人未來的生活照顧技能，除轉介居家護理師定期追蹤外，建議協助病人轉介康復之家或社區復健中心學習一技之長，以培訓病人具備自立生活的能力。

This article describes the nursing care experience of a patient with schizophrenia who experienced recurrent hospitalizations due to insufficient insight into the illness and nonadherence to prescribed medication. The nursing care period extended from December 30, 2023, to January 29, 2024. Data were collected through direct nursing care, patient interviews, behavioral observations, and review of medical records. A holistic nursing assessment was conducted based on five dimensions: physical, psychological, intellectual, social, and spiritual aspects. Upon analysis, three primary nursing problems were identified: disturbances in sensory perception, knowledge deficit related to the illness, and impaired social interaction. Nursing interventions included educating the patient to use symptom-recording cards to document psychiatric symptoms and medication effects, as well as teaching coping strategies for managing symptoms when they occurred. These interventions aimed to enhance the patient's understanding of the illness and to strengthen the ability to differentiate between realitybased experiences and psychotic symptoms. In addition, participation in group activities was utilized to facilitate the development of social skills. Through repeated practice, the patient's self-confidence and positive expectations were reinforced, ultimately resulting in a successful discharge with good symptom control and improved medication adherence. Considering the patient's parents were of advanced age and expressed concerns regarding the patient's future ability to manage daily living, referrals were made to a home care nurse for regular follow-up. Furthermore, recommendations were provided to assist the patient in being referred to a halfway house or a community psychiatric rehabilitation center, where vocational training and daily living skills could be developed to promote independent living.