照顧一位腦中風後產生壓傷之病人與照顧者的居家護理經驗

Home Care Experience for a Stroke Patient with Pressure Injury and Her Primary Caregivers

黃如玉(Ru-Yu Huang)

《馬偕護理雜誌》 14卷1期 (2020/01) Pp. 48-58

https://doi.org/10.29415/JMKN.202001_14(1).0005

摘要

本文為描述一名跌倒引發腦中風後肢體癱瘓接受居家照顧有壓傷問題之個案，續探討壓傷傷口照護及家屬對於疾病所產生的照顧心理困境之護理經驗。筆者自2018年4月4日至5月30日居家訪視照護期間（家庭訪視9次，電話訪視4次）。藉由觀察、會談、身體評估等方式收集資料，確立個案之護理問題：一、組織完整性受損／與身體固定不動皮膚長時間受壓及照顧者對壓傷照顧知能不足有關，二、照顧者角色緊張／個案需要長期照顧及家庭支持系統薄弱有關，三、焦慮／與疾病預後未知及無壓傷照顧經驗有關。護理過程以同理心及主動關心案家需求，照護期間藉由指導家屬傷口照護技巧及相關注意事項，減緩傷口惡化，協助案家能夠面對疾病的所帶來的衝擊，並予以心理支持與陪伴，減輕焦慮情形。於此，提出此護理經驗供以臨床醫療人員及居家照護人員之參考。

關鍵字

腦中風 ； 壓力性損傷 ； 居家護理 ； 照顧者緊張 ； 焦慮

並列摘要

This article described the home care experience for a stroke patient and her primary family caregiver(s) in which the nursing process included a specific care plan for pressure injuries due to immobility (limb paralysis) and emotional distress of family caregiver(s). Home care was provided from April 4th to May 30th, 2018 to consist 9 home visits and 4 telephone interviews; during this period of time, both qualitative and quantitative information was collected through observations, interviewing, and physical assessments. Major health problems were identified: 1) the impaired skin integrity which was related to immobility and insufficient caregiver knowledge of pressure injury prevention, 2) role strain of the caregiver(s) due to long term care needs and insufficient family support, and 3) anxiety from apprehensiveness about disease prognosis and the lack of pressure injury care experience. With proper supplement of wound care knowledge and skills, not only the condition of pressure injuries has improved, but the primary caregiver(s) also have shown less anxiety and a better ability to deal with emotional distress when home care workers provided empathy, psychological support, and companionship.

並列關鍵字

stroke ； pressure injury ； home care ； caregiver role strain ； anxiety