運用跨領域團隊合作模式於一位頭部創傷病童之照護經驗

Nursing Experience of Using Inter-Professional Collaborative Practice in a Traumatic Brain Injury Child

潘美日(Mei-Jih Pan) ； 周利娜(Li-Na Chou)

《新臺北護理期刊》 21卷2期 (2019/09) Pp. 123-133

https://doi.org/10.6540/NTJN.201909_21(2).0011

摘要

本個案報告運用跨領域團隊合作模式於一位頭部創傷病童之照護經驗。個案因嚴重創傷性腦損傷導致右側肢體無力臥床，需依賴鼻胃管進食。照護期間為2016年8月2日至8月14日，藉由觀察、訪談及直接參與照護等方式收集資料，應用生理、心理、家庭社會及靈性層面進行護理評估，歸納出個案的健康照護問題，含營養失衡：少於身體需要、排尿型態障礙、身體活動功能障礙、照顧者角色緊張。跨領域照護團隊依個案喜愛食物規劃專屬營養衛教而增加熱量攝取；教導足夠水分攝取與泌尿道清潔，配合抗生素治療；教導復健活動融入日常生活與遊戲，促進肢體活動功能進步；透過關懷與陪伴及引導案母說出內心感受，教導案母正確執行鼻胃管餵食與復健照護技能，擬定個案之生活作息表，鼓勵家庭成員參與個案照護，以減輕案母焦慮及壓力，促使個案出院後能適宜地銜接居家照顧。建議護理人員照護頭部創傷病童可藉由跨領域團隊合作模式，全方位地滿足個案與家屬的照顧需求，同時提升照護品質。

關鍵字

頭部創傷 ； 兒童 ； 跨團隊照護

並列摘要

This article discussed the nursing experience of using inter-professional collaborative practice to care the child who had traumatic brain injury. During the nursing care period from August 2 to August 14 2016, the authors collected data through direct care observations, interviews, and physical, psychological, and social assessment to generalize the health problems which included imbalanced nutrition: less than body requirement, impaired urinary elimination, impaired physical mobility, and caregiver role strain. As nurse practitioners, we used inter-professional collaborative practice, team discussions, holistic health assessment, and execution of the family-center care plans to meet the requirements of the child and his families. To increase calorie intake, nutritional diets were designed in accordance with the child food preferences. To prevent urinary tract infection, sufficient water intake was provided, and clean urinary tract and antibiotics treatment were maintained. To improve physical functions, rehabilitation exercise assimilated with games and daily activities was instructed. To relive caregiver role strain, nasogastric tube feeding and rehabilitation exercise were taught. The family members were encouraged to participate in home care to relive caregiver's anxiety and offer appropriate family care after discharge. We suggested the inter-professional collaborative practice care model could meet the needs of children with head trauma and their family and thus promote nursing home care quality.

並列關鍵字

traumatic brain injury ； children ； inter-professional collaborative practice

參考文獻

行政院衛生福利部（2018，6月15日）‧106年國人死因統計結果‧取自https://www.mohw.gov.tw/cp-16-41794-1.html

李典蓉、李美銀（2018）‧運用 Watson 關懷理論照護一位急性泌尿道感染之平腦症幼童的護理經驗‧馬偕護理雜誌，12（2），30-42。

李秋璇、廖玟君（2011）‧照護一位頭部外傷青少年病患之護理經驗‧中山醫學雜誌，22（3），341-348。

柯亦芳、游顯妹（2011）‧照顧一位頭部外傷導致顱內出血患者之護理經驗‧中山醫學雜誌，22（2），253-262。

徐春花、王境堪、張虹珠（2011）‧照顧一位頭部創傷併長期臥床個案之居家護理經驗‧馬偕護理雜誌，5（2），80-88。