一位續發性腦中風病人併無望感之護理經驗

The Nursing Experience of Caring for a Patient with Hopelessness after a Recurrent Stroke

林怡伶(Yi-Ling Lin) ； 唐秋花(Ciou-Hua Tong) ； 李春綢(Chun-Chou Lee) ； 謝春滿(Chun-Man Hsieh)

《馬偕護理雜誌》 10卷1期 (2016/01) Pp. 91-101

https://doi.org/10.29415/JMKN.201601_10(1).0008

摘要

希望能帶給人內心踏實、平安面對未來，本文旨在探討一位續發性腦中風患者因無望感而影響其疾病適應，協助面對復健與預後而恢復信心之照護經驗。筆者於2013年7月1日至7月10日照護期間，透過觀察、訪談、身體評估、病歷查閱、直接照護等方式收集資料，統整為四大層面之整體性護理評估。確立主要健康問題有：無望感、身體活動功能障礙、自我照顧缺失、睡眠障礙、營養狀況改變：少於身體需要、認知缺失（特定於腦中風飲食及復健）、潛在危險性跌倒。針對前三項主要健康問題說明護理過程，運用Watson關懷理論及專業團隊合作，與個案重建信任與治療性關係，增進並接受正負向情緒表達，透過護理指導與護病互動促進個案參與日常生活自我照顧、正向面對疾病衝擊，對疾病預後及未來有正向感受與希望。個案出院後極需持續追蹤照護成效，但受限於出院後持續性照護銜接尚未完善，建議啟動腦中風追蹤照護網，及早發現問題並處理，期望本文經驗作為日後照護類似個案之參考。

關鍵字

中風 ； 無望感 ； Watson理論 ； 關懷 ； 護理

並列摘要

Hope brings human with physical, psychological and social well-being. The purpose of this case study was to share a nursing experience of caring for a patient with hopelessness after a recurrent stroke to overcome the process of recovery and rehabilitation. The nursing period was from July 1 to July 10, 2013. The author collected data via observation, conversation, physical examination and medical records review and identified nursing problems included hopelessness, impaired physical mobility, self-care deficit, altered nutrition: less than body requirement, knowledge deficit (in stroke diet and rehabilitation), and potential risk of falls. Based on the core health issues, the author analyzed the concept of hopelessness and indicated four issues: negative emotion, lack of sense of self-control, improper adjustment mechanism, and developing positive self-adjusting mechanism. The Watson's caring theory and team work were applied into nursing process. The interventions included establishing a trust and therapeutic relationship, encouraging expression of positive and negative perceptions, and participation in the self-care activity through interactive learning. Through these approaches, the patient could adapt to his current life, changed as it was by the illnesses, and face the impact of those illnesses with a positive attitude. It is important to follow-up care outcome after the patient being discharged home, but there is no consensus about the way to organize long-term follow-up plan. It is recommended adding a structured follow-up care after stroke to identify and resolve the stroke related problems. We hope this experience provides other nurses with information about caring for post-stroke patients with hopelessness in the future.

並列關鍵字

stroke ； hopelessness ； Watson's theory ； caring ； nursing