照顧一位邊緣性人格疾患靈性困擾之護理經驗

Nursing Care Experiences of a Borderline Personality Patient With Spiritual Distress

邊緣性人格疾患，常對人生、存活價值產生質疑，若能瞭解及提供個案的靈性健康需求，是極具價值和有意義的護理經驗。本篇個案報告探討一位邊緣性人格疾患的年輕女性，產生靈性困擾之護理經驗，護理期間自2010年2月24日至2010年12月15日，利用觀察、會談和查閱病歷進行靈性照護需求四向度評估，包括個人與自我、他人、信仰及自然環境間的關係，加以彙整分析資料後，發現個案因疾病憂鬱情緒、過去成長背景缺失、缺乏支持系統及有效壓力調適技巧、造成個人生命存活價值的質疑，有自殺及自傷的行為表現；在此護理過程中，筆者以個別會談方式運用傾聽技巧、誘導個案表達靈性的困擾，進而以辯證行為治療團體、教導技巧訓練，增強正向思考的價值觀，降低自殺或自傷的行為出現，使個案能對生命存在意義有較正向的看法，增加個案的自我尊重和生活品質，藉此提供日後照顧類似臨床個案的參考。

Patients with Borderline Personality Disorder (BPD) often question the purpose and value of their life. Understanding the spiritual needs of BPD patients is essential to providing more appropriate care and achieving greater care efficacy. This case report investigated a woman with BPD who had experienced spiritual distress during nursing care. Between February 24th and December 15th, 2010, the authors conducted an assessment of the four dimensions of spiritual care for the patient using observation, interviews and patient medical records. The four dimensions included the relations between the individual and herself, others, religious belief, and the natural environment. After integrating and analyzing data, the authors found the patient questioned the purpose and value of her life and contemplated self-injury / suicide due to inadequate support systems and a lack of effective stress management and coping skills caused by illness-induced depression and the lingering effects of a difficult childhood. In the process of nursing care, the authors employed one-to-one interviews with listening skills to induce the patient to describe her spiritual distress, and then employed dialectical behavior therapy groups and education skills training to enhance the values of positive thinking and reduce suicidal / self-injury tendencies to help the patient foster a more positive outlook toward life. The result increased patient self-respect and quality of life. The authors hope this case may provide a reference for treating similar clinical cases in the future.