一位社區型肺炎合併氣切造口老人之護理經驗

台灣進入老人國之後，照顧者趨向高齡的現象亦隨之而來，本文即在描述一位社區型肺炎合併氣切老人及其高齡主要照顧者之護理經驗。在2015年7月1日～7月25日，筆者透過直接照護、身體評估、病歷檢視及出院後電訪等方式收集資料，再依據戈登十一項健康功能型態進行資料彙整，發現「呼吸道清除功能失效」、「言辭溝通障礙」、「照顧者角色緊張」等三個健康問題。筆者運用呼吸及運動訓練與胸腔物理治療，暢通個案之呼吸道；照會語言及呼吸治療裝置發聲閥，解決其溝通障礙的挫折感。更依據照顧者年長的發展特質，研擬客製化適用於高齡的圖文衛教內容及輔助教學工具，指導居家照護技巧，並召開家庭會議，評估返家照護需求，介入出院準備服務，整合醫療團隊及長期照護資源，提供案家社會支援，緩解高齡案子的照顧者角色緊張。本文提供住院銜接居家照護之持續性護理經驗，期能作為氣切病人相似案例照護之參考。

關鍵字

社區性肺炎；氣切造口；發聲閥；照顧者角色緊張

並列摘要

The onset of an ageing society in Taiwan has led to the prevailing phenomenon of ageing care-givers caring for elderly family members. This article describes home-based nursing care for an elderly tracheostomy patient with community-acquired pneumonia by a similarly elderly family member. For the nursing period 1 July to 25 July 2015, the authors employed bedside care, physical assessment, medical records review and telephone interviews to collect data before using Gordon's 11 Functional Health Patterns to analyze the data. The model discovered three different health issues i.e. ineffective airway clearance, impaired verbal communication, and caregiver role strain. The authors designed a treatment regimen based on the outcome of the nursing care involving multiple specialists, including a respiratory specialist to teach the patient correct breathing and airway clearing techniques and a vocal therapist to insert a speaking-valve into the patient’s tracheostomy and to train the patient to communicate through the device. This immediately resulted in decreased patient frustration due to an inability to communicate with others. In addition the authors developed tailor-made assistive teaching materials to improve the home care skills of the senior caregiver to also release caregiver stress. Family meetings were held to assess the patient's home-care needs, to integrate the multiple opinions of medical experts in the care regimen as well as to determine the necessary further assistance required by the patient based on the hospital discharge planning concept. This paper offers an insight into a continuing nursing care experience of an elderly tracheostomy patient with community- acquired pneumonia from hospital care to home-based care.

並列關鍵字

Community-acquired Pneumonia ； tracheostomy ； speaking valves ； caregiver role strain

參考文獻

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陳亮汝、蔡麗珍(2012) • 影響出院準備服務個案使用不同長期照護服務之因素 • 醫務管理期刊，13(3)，190-206。doi:10.6174/JHM2012.13(3).190

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一位社區型肺炎合併氣切造口老人之護理經驗

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