照顧一位腦內出血合併無力感病人之照護經驗

本文旨在描述一位68歲男性因突如其來的腦內出血導致右側肢體乏力，頓時失去身體自我控制能力，導致日常生活無法自理，經復健治療一週仍未達到期望之復健成效，進而出現低頭不語、表情落寞且不願配合復健治療等負向情緒。筆者於照護期間2017年2月24日～3月24日，運用Miller七種力量來源進行身體評估、觀察、與個案及家屬會談等技巧收集資料，發現個案有身體活動功能障礙、自我照顧能力缺失、無力感等護理問題，偕同物理治療師、職能治療師運用團隊合作與適切的護理措施協助個案減少負向情緒及無力感，正向面對疾病導致的功能障礙，積極復健治療提升自我照護能力、改善生活品質以達到身心適應的狀態。然而筆者著重生理照護，缺乏心理層面護理經驗，以致無法於第一時間給予適切的護理措施；因此建議定期舉辦相關在職教育及護理新知分享，及早發現病人心理層面問題並給予協助，期能藉此案例分享，提供臨床護理人員照護參考。

關鍵字

腦內出血； Miller力量來源；無力感

並列摘要

This study aimed to describe the nursing experience of treating a 68-year-old male patient who was suffering from weakness in the right limbs due to a sudden intracerebral hemorrhage and, consequently, lost his ability to perform daily life functions. Despite undergoing a week-long rehabilitation, the patient failed to attain the rehabilitation effect that he desired, and subsequently experienced negative emotions that caused him to become withdrawn and quiet, emotionally unexpressive, and unwilling to cooperate with respect to his rehabilitation therapy. The patient received nursing care from February 24 to March 24, 2017, during which time the author applied Miller's seven sources of power and conducted physical assessments, observations, and family discussions in order to collect data. It was revealed that the patient was suffering from problems such as physical activity dysfunction, lack of self-care ability, and powerlessness. With the help of physiotherapists and occupational therapists, the appropriate nursing care measures were implemented to help alleviate the patient's negative emotions and powerlessness, and to motivate him to face his disease-related dysfunctions and perform his own rehabilitation in a positive manner, such that he was able to improve his self-care ability, quality of life, and make physical and mental adaptations. However, the author's focus on physical care and lack of experience in the psychological aspects of nursing care prevented the timely implementation of appropriate nursing measures. It is thus suggested that on-the-job education and knowledge sharing sessions could be conducted regularly, so as to enhance the nursing staff's ability to detect a patient's psychological problems and assist him or her. It is hoped that this case study will serve as a reference in clinical nursing.

並列關鍵字

intracerebral hemorrhage ； Miller's sources of power ； powerlessness

參考文獻

Dastur, C. K., & Yu, W. (2017). Current management of spontaneous intracerebral hemorrhage. Stroke and Vascular Neurology, 2(1), 21-29. doi:10.1136/svn-2016-000047

Ziejka, K., Skrzypek-Czerko, M., & Karłowicz, A. (2015). The Importance of Stroke Rehabilitation to Improve the Functional Status of Patients with Ischemic Stroke. The Journal of Neurological and Neurosurgical Nursing, 4(4), 178-183. doi: 10.15225/PNN.2015.4.4.6

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