支持性心理治療照顧解離性身份障礙疾患之護理經驗

A Nursing Experience Using Supportive Psychotherapy in a Patient With Dissociation Identity Disorder

本篇是敘述一位28歲未婚女性個案，因情緒低落、自傷想法及人格轉變症狀出現頻繁而入院，診斷為Dissociation identity disorder。筆者利用Gordon十一項健康功能評估，發現有「潛在危險性自傷」、「個人因應能力失調」、「家庭因應能力失調」等健康問題。護理過程運用支持性心理治療方法，並以維護個人安全、發展良好壓力因應方法及建立良好支持系統為照護策略。個案住院期間無自傷行為及出現人格轉變症狀，能以轉移注意力及消耗體能為壓力因應方法，並獲得重要關係人的支持。因此種疾病之個案臨床少見，亦乏文獻報告，故藉此護理經驗，提供護理同仁在照顧此類病患時做參考。

This article describes a nursing experience of an unmarried woman patient,who was admitted to this hospital due to depressive mood, self harm ideation and depersonalization. She was diagnosed to have dissociation identity disorder.Using Gordon’s 11 functional health assessment guides, the authors determined that the patient’s health problems include drisk for self-mutilation,as well as compromised and ineffective individual and family coping skills.During the nursing process, the authors used Supportive Psychotherapy and followed the stratagems thereof to conserve the patient’s individual safety.We also sought to develop within her positive individual coping skills and assist in establishing an effective support system. Finally, the patient,without risk of self-mutilation and depersonalization within the hospital learned that she could use positive coping skills when she was in stress. In addition, she also acquired positive support from her family.Because this case is infrequently seen in clinical settings, the authors hope that through documenting this experience it may provide other nursing professionals understanding and useful knowledge to apply to suchpatients.