Yu Hui-Wen, Huang Yen-Ju, Ma Wei-Fen
BSN, RN, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Taiwan, ROC.
MS, RN, Head Nurse, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Taiwan, ROC.
Hu Li Za Zhi. 2018 Oct;65(5):112-119. doi: 10.6224/JN.201810_65(5).14.
This case report describes a nursing experience caring for a patient with schizophrenia and obsessive-compulsive symptoms. This patient suffered from symptoms of being controlled, obsessive thoughts, and compulsive behaviors. In addition, the patient showed no interest in implementing strategies for dealing with anxiety, no motivation for changing this suffering, and an inability to receive a higher level of rehabilitative job training in daycare. These problems impeded this patient's reintegration into the community. Therefore, the authors employed a five-dimension assessment (physical, emotional, cognitive, social, and spiritual) in order to address the two major nursing problems. The period of nursing care was from October 21, 2016 to January 10, 2017. The two nursing problems addressed included: 1) altered thought processes and 2) ineffective coping. The author provided potentially helpful nursing processes based on the theory of Rational-Emotive Behavior Therapy in order to help the patient cope with symptoms, including being controlled and obsessive-compulsive behaviors. Meanwhile, a relaxation technique was applied to reduce the patient's feelings of discomfort during the nursing processes. As a result, the patient's coping skills to deal with symptoms of being controlled, obsession, and compulsion were improved through refutation of irrational beliefs. In addition to showing rational emotions and appropriate behavior to handle pressures, the patient was also able to apply the relaxation technique to relieve the discomfort from anxiety and pain as needed. This case report suggests that nurses may implement the irrational beliefs refutation training regimen under Rational-Emotive Behavior Therapy for similar cases at the beginning of nursing-patients relationships. Furthermore, providing relaxation techniques in the nursing process may assist patients to deal with stressful life events. The results of this nursing experience are expected to help nursing colleagues apply the above theory and skills with schizophrenia patients with obsessive-compulsive symptoms.
本病例报告描述了对一名患有精神分裂症和强迫症状患者的护理经历。该患者存在被控制感、强迫观念和强迫行为等症状。此外,患者对实施应对焦虑的策略毫无兴趣,没有改变这种痛苦状况的动机,并且无法在日间护理中心接受更高水平的康复职业培训。这些问题阻碍了该患者重新融入社区。因此,作者采用了五维评估(身体、情感、认知、社会和精神)来解决两个主要的护理问题。护理期为2016年10月21日至2017年1月10日。所解决的两个护理问题包括:1)思维过程改变和2)应对无效。作者基于理性情绪行为疗法理论提供了可能有帮助的护理过程,以帮助患者应对症状,包括被控制感和强迫行为。同时,应用了一种放松技巧来减轻患者在护理过程中的不适感。结果,通过驳斥不合理信念,患者应对被控制、强迫观念和强迫行为症状的技能得到了改善。除了表现出理性情绪和适当行为来应对压力外,患者还能够根据需要应用放松技巧来缓解焦虑和疼痛带来的不适。本病例报告表明,护士在护患关系开始时,可针对类似病例实施理性情绪行为疗法下的不合理信念驳斥训练方案。此外,在护理过程中提供放松技巧可能有助于患者应对压力较大的生活事件。期望这一护理经验的结果能帮助护理同行将上述理论和技能应用于患有强迫症状的精神分裂症患者。