照護一位基底核出血術後病人於加護病房之護理經驗

Nursing Experience of Providing Postoperative Care to a Patient with Basal Ganglia Hemorrhage in the Intensive Care Unit

周稜穎(Leng-Ying Chou) ； 林昀(Yun Lin) ； 葉淑敏(Shu-Min Yeh)

《領導護理》 21卷2期 (2020/06) Pp. 31-45

https://doi.org/10.29494/LN.202006_21(2).0004

摘要

本篇為敘述一位基底核出血術後病人的加護經驗。住院期間無法接受疾病及右側肢體乏力產生焦慮不安，造成主要照顧者角色緊張之健康問題，護理期間於2017年9月12日至9月17日，過程利用傾聽、觀察、會談方式收集資料，並運用Gordon十一項功能性健康型態進行評估，發現個案有三個主要健康問題為：照顧者角色緊張、焦慮、身體活動功能障礙。透過聆聽與評估了解案子需求增加探視次數及時間，提供醫療跨團隊諮詢，以澄清主要照顧者疑問，有效改善主要照顧者角色緊張；期間藉由主動陪伴及說明管路功能，增加個案於加護病房治療的安全感，當病情穩定後協助和指導正確執行被動全關節運動、屈曲復健訓練計劃，並鼓勵表達內心感受給予心理支持等護理措施，增加個案與主要照顧者的信心與希望，期望藉由此照護經驗分享，提升臨床加護病房的照護品質。

關鍵字

基底核出血 ； 照顧者角色緊張 ； 焦慮 ； 身體活動功能障礙

並列摘要

This paper describes the postoperative care experience from caring a patient with basal ganglia hemorrhage in the intensive care unit (ICU). During the patient's hospital stay, the patient had considerable difficulty accepting the illness and the muscle weakness in the right extremities; consequently, the patient became anxious, and caused primary caregiver role strain. The caring period was September 12 to 17, 2017. During this period, this study applied the methods of empathetic listening, observation, and interview to collect data and also utilized Gordon's eleven functional health patterns to evaluate those data. The patient exhibited three major health concerns: caregiver role strain, anxiety, and physical disability. The medical personnel increased the frequency and duration of visits to the patient after empathetically listening to the patient and understanding the patient's need to further provide cross medical teams' consultation. Moreover, consultations with various members of the medical teams were arranged to clarify the doubts of the primary caregiver and effectively improve the tension of the primary caregiver. During the caring period, the patient received active companionship and explanations concerning the functions of the various tubes required for treatment. This was done to increase the patient's sense of security during ICU treatment. After the condition stabilized, the patient received assistance and instructions for correct execution of passive range of motion exercises and flexion rehabilitation training plan. At the same time, encourage the expression of inner feelings and give psychological support and other nursing care measures. Hence increases the confidence and hope of the case studied as well as the primary caregiver. It is hoped that through sharing this caring experience, the quality of care in clinical intensive care units will be improved.

並列關鍵字

basal ganglia hemorrhage ； causing caregiver role strain ； anxiety ； physical disability

參考文獻

吳冠穎、吳肖琪、洪燕妮、吳君誠、林麗嬋、胡漢華（2012）．台灣腦中風病人急性後期照護需要之探討．台灣公共衛生雜誌，31(3)，251-262 。 doi:10.6288/TJPH2012-31-03-05

邱佳音、黃冠升、黃菁萱、黃欣怡、徐南麗、王美惠（2014）．加護病房家屬需求探討．健康與建築雜誌，1(3)，60-67。doi:10.6299/ JHA.2014.1.3.R6.60

林佳淑、吳麗珍（2013）．轉銜期照護模式對腦中風病患之成效探討．護理暨健康照護研究，9(2)，116-126。doi:10.6225/JNHR.09.2.116

潘宏慧（2016）．中風患者的心理適應．血管醫學防治季刊，26，12-13。doi:10.6527/PVM.2016.26.6

韓德生、林家瑋、盧璐、蕭名彥、吳爵宏、梁蕙雯···張權維（2016）．臺灣腦中風復健治療指引．台灣復健醫學雜誌，44(1)，1-9。doi: 10.6315/2016.44(1)01