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| 題 名 | 運用認知重塑與行為治療於一位思覺失調症個案之護理經驗=Application of Cognitive Restructuring and Behavioral Therapy in the Nursing Care of a Patient with Schizophrenia |
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| 作 者 | 官芷安; 許佳茵; | 書刊名 | 精神衛生護理雜誌 |
| 卷 期 | 20:2 2025.08[民114.08] |
| 頁 次 | 頁44-50 |
| 分類號 | 419.85 |
| 關鍵詞 | 認知重塑; 行為治療; 代幣; 思覺失調症; 幻聽; 水中毒; Cognitive restructuring; Behavioral therapy; Token economy; Schizophrenia; Auditory hallucination; Water intoxication; |
| 語 文 | 中文(Chinese) |
| DOI | 10.6847/TJPMHN.202508_20(2).06 |
| 中文摘要 | 本文為應用認知重塑與行為治療的原則於一位思覺失調症個案之護理經驗。個案長期安置在慢性病房,常因嚴重幻聽及過度飲水,轉至急性病房治療,引起筆者照護動機。照護期間為2023年3月1日至2023年4月16日,藉由身體評估、會談、觀察及查閱病歷等方式收集資料,運用整體性護理評估為架構,確立個案有知覺感受變異及潛在體液電解質不平衡等健康問題。筆者首先與個案建立治療性護病關係,知覺感受變異部分,評估個案幻聽來源及內容,教導幻聽管理策略、認知重塑並提早介入;潛在體液電解質不平衡部分,提供水中毒相關知識,衛教可用漱口、加檸檬汁來降低口渴感受,利用認知重塑改善個案對飲水的非理性思考,製作飲水時刻表,同時運用代幣制度,提升個案改變動機。結果發現認知重塑與行為治療可有效改善個案幻聽及過度飲水之問題,以十分法評估幻聽干擾程度由8分降至4分,飲水量減少1,500~2,000 mL。建議照顧慢性精神疾病、缺乏改變動機之個案時,善用認知重塑與行為治療的原則,並透過持續練習相關技巧,提升個案的參與動機,進而穩定病情和提升生活品質。 |
| 英文摘要 | This paper presents a nursing experience involving the application of cognitive restructuring and behavioral therapy to the care of a patient with schizophrenia. The patient had been residing long-term in a chronic psychiatric ward and was frequently transferred to an acute ward because of severe auditory hallucinations and excessive water consumption, which prompted the author's motivation to intervene. The care period spanned from March 1 to April 16, 2023. Data were collected through physical assessments, interviews, observations, and review of medical records. Using a holistic nursing assessment framework, the patient was identified as having health problems including sensory perception disturbance and potential fluid and electrolyte imbalance. The author first established a therapeutic nurse-patient relationship. Sensory perception disturbance was addressed by assessing the source and content of the patient's auditory hallucinations, providing instructions on hallucination management strategies, introducing cognitive restructuring, and implementing early intervention. Potential fluid and electrolyte imbalance was addressed by providing education on water intoxication and instructing the patient to use mouth rinsing and lemon water to alleviate sensations of thirst. Cognitive restructuring was applied to modify the patient's irrational thoughts about water intake, a structured drinking schedule was developed, and a token economy system was implemented to enhance motivation for behavioral change. The results demonstrated that cognitive restructuring and behavioral therapy effectively reduced the severity of auditory hallucinations and excessive water intake. The perceived interference from hallucinations, assessed using a 10-point scale, decreased from 8 to 4, and daily water intake was reduced by approximately 1,500-2,000 mL. This experience suggests that when caring for patients with chronic psychiatric disorders who lack motivation for change, applying the principles of cognitive restructuring and behavioral therapy-along with continuous practice of related techniques-can enhance patients' engagement, stabilize their medical conditions, and improve their quality of life. |
本系統中英文摘要資訊取自各篇刊載內容。