- 期刊
一位因跌倒導致腦部創傷老人之重症護理經驗：以病人及家庭為中心的照護模式
The Critical Nursing Care Experience of a Falling Elderly Patient with Traumatic Brain Injury based on the Patient and Family Centered Care
摘要
跌倒常是造成居家老人腦部創傷之主因，有跌倒病史者更容易再次跌倒而導致腦部創傷，而腦部創傷後所產生的身體、情緒、行為及認知等障礙，對病人與家庭帶來極大身心衝擊，除了須提供病人急性期的照護外，更需要給予家屬心理安慰及衛教後續照護個案之技巧。本文運用以病人及家庭為中心(Patient and Family Centered Care, PFCC)之理念於重症加護中心，提供一位因白內障術後及頭暈而意外跌倒造成腦部創傷的75歲老人整體性及個別性之照護。筆者於103年11月18日到103年11月26日間照顧個案，照護期間筆者陪同家屬經歷個案病情危急、因意識突然變化，而緊急接受腦室外引流手術之身心衝擊與壓力。筆者藉由觀察、深入會談及身體評估等方法進行資料收集，評估個案及其家庭的生理、心理、靈性、社會等層面的健康需求，發現存在個案相關護理問題為腦組織灌流改變、居家照護重症家人之家庭壓力及潛在危險性再次跌倒等。筆者運用實證資料研擬具體護理照護措施，以協助個案維持腦部正常血流以降低腦部的損傷，且筆者主動提供家屬相關病人完整及詳細的治療狀況，以降低家屬的壓力與擔憂，並提供轉出病房後續的照顧資訊，以促進家屬對於腦部創傷後所造成身心障礙的因應與調適。同時，於個案接受加護治療期間，提供預防再次跌倒之策略，以確保返家照護上的安全。
並列摘要
Accidental falls are the major cause of traumatic brain injury among elderly community members. Elderly people who have a history of falls are likely to fall again and are vulnerable to brain injury. Traumatic brain injury may compromise the physical, emotional, behavioral, and cognitive functions of elderly patients and might engender considerable physical and mental effects on the patients and their family caregivers. Nurses are required to provide patients with an acute care phase as well as to offer mental support to the patients' family members and teach them care skills. In this study, the Patient and Family Centered Care (PFCC) in addition to holistic and individualized intensive nursing care were provided to a 75-year-old patient who had traumatic brain injury induced by an accidental fall because of an episode of dizziness just after a cataract surgery. The author provided primary and direct care to this patient from November 18 to November 26, 2014. During the intensive care period, the author accompanied the patient and family caregivers to experience the challenges posed by the patient's critical condition and acute consciousness changed and received emergency surgery for extra-ventricular brain drainage. To comprehend the patient's and family caregivers' physiological, psychological, spiritual, and social needs, the author evaluated them through observation, in-depth interviews, and physical assessment. Three major problems were found in this patient: ineffective cerebral tissue perfusion, the family caregivers' stress related to caring for the critically ill patient at home, and the high risk of recurrent falls. An evidence-based nursing protocol was used to care for this patient. Nursing interventions emphasized maintaining normal cerebral blood perfusion to reduce brain damage, providing detailed information related to the patient's medical condition, administering treatment to reduce the stress and anxiety of the patient's family members, and preventing recurrent falls to ensure home care safety. In addition, the nursing care information of post intensive care was provided to promote family coping and adaptation of patient's physiological and psychological impairment, and also to achieve successful transition of post- ICU discharge for family caregivers.
參考文獻
延伸閱讀
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