有自杀观念和行为出现,多见于疾病久治不愈、反复发作的情况下。由于症状的反复发作,使病人不能像常人一样生活。这种无用感会使病人产生悲观厌世的情绪,严重者可出现自杀观念和行为。有时病人的言语中流露出来,有时出现一些迹象:如藏药、藏危险物品反常的行为。另外,若工作人员对病人使用粗暴的言语和行为去干扰,制止病人强迫行为,有时会严重地伤害病人的自尊心,打破病人的“平衡”。而更加重自卑和无用感,出现强烈的情绪反应和过激行为。这是护理技巧的不良使用给病人造成的负性心理反应。
护理措施:
(1)做好病人的心理护理,以支持心理治疗为主要内容,坚定病人的治疗信心。在病人的病情有所改善时,及时予以肯定,鼓励病人,让病人看到希望和光明,对病的康复抱乐观的态度而不是绝望。
(2)与病人建立有效的沟通,了解病人的内心体验、感受,了解病人的情绪反应类型,有助于及时、准确地掌握病人的情绪变化,并采取必要的防范措施,预防问题的发生。
(3)注意沟通技巧,讲究语言的使用。避免使用中伤性的语言和使用粗暴的行为去制止病人的强迫动作和行为。如强迫将病人保护起来而不做任何的解释,或斥责病人:“烦死了”、“假干净”等。要防止伤害病人的自尊心,考虑病人的心理承受能力。
(4)对有强烈自杀企图和行为的病人进行保护性约束时,要向病人讲清保护的目的。否则,病人会误解为保护是对他的惩罚而加重与医护的对立情绪而出现极端的行为反应。
(5)按“防自杀护理常规”护理。
3.皮肤完整性受损表现为皮肤损伤与反复洗涤有关。
频繁、长期的强迫洗涤,损伤了皮肤部位保护层,使被洗涤处的皮肤——手、脸等部位皮肤干燥、鼓裂、红肿、失去弹性,皮肤的营养度降低及发生感染等。
护理措施:
(1)每日对病人洗涤处皮肤的健康情况做详细、认真的评估。了解其损伤的程度,并做交班记录。
(2)让病人使用性质温和、刺激性小的肥皂。临睡前,在皮肤上涂以护肤的营养霜或药膏。对水的温度进行控制——不能过热,以防烫伤;不能过冷,以防冻伤。
(3)为病人制定每日的活动计划。督促病人多参加工娱疗。尽可能避免让病人在有水的地方停留过长的时间,以减少病人洗涤的次数和时间。
(4)营养丰富的食物有助于提高机体和皮肤的抵抗力。可以预防皮损的损伤。
(5)对症状顽固者应适当的限定其活动范围和施行必要的保护。
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