Nehls N
School of Nursing, University of Wisconsin-Madison, USA.
Arch Psychiatr Nurs. 2000 Feb;14(1):12-8. doi: 10.1016/s0883-9417(00)80004-7.
The scope of case management has expanded to include persons with chronic, nonpsychotic disorders, in particular, persons diagnosed with borderline personality disorder. Despite more widespread use, literature about case management for persons with this disorder is limited. To address this gap in knowledge, a study of the day-to-day experiences of case managers who care for persons with borderline personality disorder was conducted. Seventeen community mental health center case managers gave their informed consent to participate in individual, in-depth interviews. The interviews were analyzed using an interpretive phenomenological research approach. The analysis showed a pattern of monitoring self-involvement. The case managers monitored themselves in terms of expressing concern and setting boundaries. These shared practices highlight a central and unique component of being a case manager for persons with borderline personality disorder, that is, the case manager's focus of attention is on self. By focusing on the self, case managers seek to retain control of the nature of the relationship. The author asserts that the matter to be resolved is not to determine whether retaining or relinquishing control is better, but rather, how best to help practitioners maintain a helpful relationship over time with persons who have borderline personality disorder. In an effort to accomplish this goal, questions about current helping practices and suggestions for working collaboratively with persons who have this diagnosis are provided.
病例管理的范围已经扩大，包括患有慢性非精神病性障碍的人，特别是被诊断为边缘型人格障碍的人。尽管其使用更为广泛，但关于针对这种障碍患者的病例管理的文献却很有限。为了填补这一知识空白，对照顾边缘型人格障碍患者的病例管理人员的日常经历进行了一项研究。17名社区心理健康中心的病例管理人员同意参与个人深度访谈。采用解释现象学研究方法对访谈进行了分析。分析显示出一种自我参与监测的模式。病例管理人员在表达关切和设定界限方面对自己进行监测。这些共同做法凸显了作为边缘型人格障碍患者的病例管理人员的一个核心且独特的组成部分，即病例管理人员的关注焦点是自我。通过关注自我，病例管理人员试图保持对关系性质的掌控。作者断言，需要解决的问题不是确定保持或放弃掌控哪种更好，而是如何最好地帮助从业者随着时间推移与边缘型人格障碍患者保持有益的关系。为了实现这一目标，提供了关于当前帮助做法的问题以及与患有这种诊断的人合作的建议。
