一位邊緣型人格違常個案的護理經驗

Nursing Care for a Patient With Borderline Personality Disorder

人格特質（personality-trait）是一個人面對外界客觀環境時其獨特且持續的觀察、思考及因應方式，會長期地影響個體對環境適應及個人認同的行為能力。本文主要陳述一位「邊緣型人格違常」個案的護理經驗。患者自入院後出現重覆的自殺行為、強烈的情緒變動、兩極化的認知思考及社交模式與工作適應困難等行為，筆者藉由護理過程中案主主訴、固定會談及病室內行為觀察等方式收集資料，其中運用身體、情緒、智能、社會、靈性等五大層面評估病人，發現個案有以下三項主要護理問題：（1）潛在危險性暴力行為：對自己；（2）個人因應能力失調：無法持續有效的社會性工作；（3）個人認同紊亂。筆者依其問題之危急性及困難度，在為期一年半的護理活動過程中，透過與個案建立穩定的治療性關係，提供個案與家屬緊急危機處置措施，建立有效的個人因應能力及支持系統，協助個案渡過自傷危機並降低自我傷害的頻率，維持持續性的有效工作因應能力，並與人建立較合宜的社交互動行為，使個案朝向穩定的自我認同發展。

Personality traits reveal characteristics and patterns of an individuals environmental observations, thinking processes, and coping strategies. They exert long-term effects on adaptation and personal identity. The author presents a case study of a patient with Borderline Personality Disorder (BPD) who suffered from suicidal ideation, intense mood swings, all-good/all-bad thinking patterns, and poor job performance. An assessment is offered of the patient’s physical, emotional, cognitive, social, and spiritual characteristics based on his subjective reports, interview records, and behavioral observations. Three primary nursing diagnoses were identified: a) potential for self-directed violence, b) ineffective coping mechanisms, and c) personal identity disturbance. A stable therapeutic relationship was formed over an 18-month period, including the establishment of coping skills, a support system, and crisis intervention training for both the patient and his family. The treatment was successful in reducing the patient’s self-mutilating behavior, increasing his stress management skills at his workplace, and developing appropriate social behaviors leading to a more stable personal identity.