協助一位失智症主要照顧者之居家照護經驗

A Home Care Experience in Helping a Caregiver who Take Care of Dementia Patient

廖淑英(Shu-Ying Liao) ； 孫宗慧(Zong-Huei Shun) ； 邱金菊(Chiu-Chin Chu)

《長期照護雜誌》 13卷2期 (2009/09) Pp. 255-268

https://doi.org/10.6317/LTC.200909_13(2).0011

摘要

失智症老人的照護，在漫長且沈重的照顧工作中，主要照顧者所承受的壓力與負荷是不可忽視的。本文在描述一位失智症患者其主要照顧者身、心、社會負荷的問題，協助減輕照顧負荷的居家照護經驗。護理期間自2007年2月1日至2007年4月30日，藉由居家訪視6次，電話訪談13次，並運用觀察、會談技巧收集資料，評估主要照顧者壓力源，經內容分析護理問題為照顧者負荷過重，包含：生活作息的限制、照顧病人知識不足、社會支持的缺乏、家庭面臨的衝擊及照顧責任的負荷等五方面的壓力源，居家護理師透過持續性關懷，運用同理心、接納及傾聽等技巧建立信任關係，並訂定照顧方針：1.提供失智症照顧知識、技巧及相關的資訊；2.透過社會支持系統的協助，有效與家庭合作，讓失智症個案、照顧者及家庭接受到完整的照顧；3.建立家庭支持系統，減少對家庭的衝擊，以協助主要照顧者增進生活品質，減輕照顧負荷。經由此次護理經驗，筆者予以下建議：一、加強溝通技巧，利用豐富專業知識，儘快建立醫療信任關係，得到照顧者信賴及配合，增強衛教的效果，降低照顧者壓力負荷；二、持續使用照顧壓力負荷評估量表，評估出照顧者的壓力負荷的變化及護理問題，給於適當的護理措施；三、照護時間及事項，予以簡單列表，讓照顧者及協助的家屬，非常清楚執行照護事項和時間；四、加強居家護理師有關於社會福利的在職教育訓練，居家護理師熟悉相關的社會資源，則會減少在轉介流程耗費的時間，減少家屬申辦的時間及心力的耗費；五、衛教手冊內容盡量採用相片，讓照顧者不用看字，看相片簡單易懂，增加閱讀的興趣及使用次數。希望藉由本篇報告經驗提供各居家護理師在照護失智症患者及主要照顧者時的一個參考，進而促進高品質的照護功能，協助更多失智症病患及照顧者渡過漫長的照顧過程。

關鍵字

失智症 ； 主要照顧者 ； 照顧者負荷

並列摘要

The article was described how to relieve the physio-psycho-social burden of a main caregiver on caring of a senile dementia case through a home-based nursing care. The home based nursing care was included within Feb, 2007 and April 2007. Throughout this period, total home-based visits and telephone-based interviews were 6 and 13 times respectively. Information was collected under adequate observations and communication skills in order to assess the burden sources of the main caregivers. The collected information was analyzed to define the causes of the burdens into 5 dimensions which were included as follows: (1) the constraint of the livelihood, (2) the inadequate caring knowledge, (3) lack of social support, (4) impact on family and (5) caring responsibility. Home-based care nurses would make use of continuous support and caring to develop the trust relationship through skill of empathy, acceptance and listening. Clear caring policy had to be planned: (1) to provide the knowledge, skills and information to care dementia, (2) to introduce the social supporting system for the case family to cope and work with, (3) to develop the family supporting system and alleviate the family burden. Through this nursing care experience, several suggestions were recommended: (1) to strengthen the communicative skill, to utilize abundant professional knowledge, to establish care trust relationship, to gain patients' coping and trust, to augment health education outcome and to minimize workload pressure on health care delivers; (2) continue to use Care Loading Assessment Tool for the evaluation of the changes of the pressure loading on the caregiver with consequence of adequate and proper nursing care; (3) to list the caring time schedule and items in a simple and readable form for the caregivers to understand and follow; (4) to consolidate the on-job education on social welfare to the home care nurses who may take less time for case review and save time for referral; (5) to picture all the materials in caring handbook which may facilitate the appreciation of the care context without much reading time and frequency. Through the efforts, the quality of life of main caregivers may improve and the pressure on caring may be decreased. The article was expected to share the experience to other home-based nursing care of how to care a dementia case and provide a care reference to dementia case for a main caregiver. Those may facilitate the caring quality and ascertain the dementia case and the main caregiver for a long caring process.

並列關鍵字

dementia ； main caregiver ； caregiver burden