運用形塑和角色模範於人格違常之護理經驗

The Nursing Experience of Applying MRM Model to Personality Disorder

本文描述一位情緒控制力不佳、操縱行為、低自尊及人際關係不良的精神分裂症併邊緣性人格違常個案之住院護理經驗。因個案住院期間其核心問題為人格部分造成，因此，本文以邊緣性人格違常為主要敘述之問題與處理，筆者以整體性護理評估，確立健康問題，發現個案有個人調適能力失調、社交互動障礙、自我概念紊亂及低自尊等健康問題，筆者運用形塑和角色模範（Modeling and Role Modeling，MRM）照護模式於人際互動過程中建立護病關係、接受其價值觀、促進個案正向的能力、建立健康的共同目標及增進控制感，並與個案共同訂定行為契約，教導以正向的言行處理情緒、改善人際關係及自我認同之歷程。在92年2月14日至92年6月10日的照護期間，個案的情緒控制、調適能力、人際關係及自我認同均有明顯改善。此結果顯示，護士以個案之觀點，瞭解個案的需要，提供個別性護理，讓個案對健康促進更有意願去參與，容易接受外在的協助，從經驗中學習與成長，亦能加強個案的自主控制與掌握人生的力量。

This article describes the nursing care of a schizophrenia patient with DSM-Ⅳ axis Ⅱ diagnosis of borderline personality disorder. The patient presented psychiatric symptoms and signs, such as poor emotional control, manipulative behaviors, low self-esteem, and poor interpersonal relationships. The core symptoms of the personality disorder led to the admission of the patient, so this article mainly deals with the problem of borderline personality and its management. Through holistic nursing assessment, the author confirmed the diagnosis and found that the patient had some related mental health problems, such as, ineffectiveness of coping skills, impairment of social interaction, disturbance of self-concept, and low self-esteem. The author therefore applied the Modeling and Role Modeling model during the process of interpersonal mutual interaction, in order to establish the nurse-patient relationship, to accept the patient's point of view, to promote the patient's capacity for positive thinking, to establish healthy goals, to enhance the sensation of control, to make behavioral contact with the patient, to teach the patient proper conduct to deal with difficulties of emotional control, to improve the patient's interpersonal relationships, and to improve the process of self-identity. During the period of care (Feb. 14th, 2003~June 6th, 2003), there was marked improvement in the patient's emotional control, adaptive abilities, and self-identity. The results revealed that, from the point of view of the patient, the nurse can improve the patient's willingness to participate in health promotion, to receive help from others, to learn and grow from past experiences and to develop the ability of self-control and mastering of one's own life.