應用紐曼模式於一抗精神病藥物惡性症候群病患及其主要照顧者之護理經驗

Applying Neuman’s Systems Model to a Neuroleptic Malignant Syndrome Psychiatric Patient and His Caregiver

本文旨在分享運用紐曼系統模式（Neuman’s Systems Model）照顧一位慢性精神分裂症併發抗精神病藥物惡性症候群病患及其主要照顧者之護理經驗。筆者護理期間為2007年10月23日至2007年12月4日，抗精神病藥物所造成惡性症候群對個案及其主要照顧者均造成衝擊，筆者先藉由紐曼模式對個案及其主要照顧者進行整體性評估，包括個人內在、人際間、人際外因素，發現個案有自我照顧功能缺失、知覺感受變異、睡眠型態紊亂等三項健康問題，主要照顧者則有照顧者角色緊張之健康問題。再針對確定之健康問題應用紐曼模式之三級護理策略，提供適切之護理措施使個案與主要照顧者系統之防禦線能力及抵抗線之抵抗作用增強，並增進其能量、恢復健康。雖然紐曼模式大多應用於內外科護理，但在精神科護理的應用亦可見其效能，達到全人完整性的護理，可做為未來護理精神病患之參考。

This article describes a nurse’s experience using Neuman’s Systems Model to care for a chronic psychiatric patient and his caregiver. The patient was diagnosed as suffering from neuroleptic malignant syndrome (NMS). Nursing care described in this article was administered from October 23 to December 4, 2007. The patient developed NMS in the third month of a three-month period of hospitalization, which endangered his life as well as the health of his caregiver. Nursing care was provided to the patient and his caregiver based on Neuman’s Systems Model, which included assessments of intrapersonal, interpersonal, and extra-personal forces as well as of environmental factors affecting the health of the patient and his caregiver. The four nursing care issues identified included: existing self-care deficit, sensory/perceptual alteration, sleep pattern disturbance, and caregiver role strain. Following Neuman’s systems model, primary, secondary, and tertiary prevention were used to strengthen the flexible lines of defense, internal lines of resistance, and supporting existing strengths of both patient and caregiver, as well as to conserve client system energy. Significant improvements in patient and caregiver abilities were apparent in nursing intervention outcomes. This experience shows the Neuman’s systems model to be an efficient model in psychiatric nursing care.