照顧一位頭部外傷術後患者及其家屬之護理經驗

本文係描述一位59歲女性因騎機車發生車禍，引起頭部外傷合併意識昏迷，導致無法脫離呼吸器之照護經驗。照護期間(94/11/06-12/20)筆者藉由柯氏量表、巴氏量表、肌力測驗等工具和運用觀察、身體評估、會談技巧及戈登11項功能性健康型態評估工具收集資料，發現個案主要的護理問題為：1.腦血流灌注改變；2.呼吸道清除功能失效；3.身體活動功能障礙；4.照顧者角色緊張。過程中，運用專業知識及技能照顧個案生理問題外，並以傾聽、同理心等技巧，鼓勵家中唯一的主要照顧者（兒子）說出內心的感受、指導照顧技巧並協助尋求資源，以克服疾病所帶來的家庭衝擊，進而正向面對漫長的照顧責任。經由護理此個案，深刻體會護理人員在照護病患的同時，亦應注意其主要照顧者之護理，提供出院準備服務，以發揮整體性的護理功能。

關鍵字

頭部外傷；照顧者角色緊張

並列摘要

This article described the nursing experience of caring a 59 years old female , having head injury and consciousness loss due to a car accident. Because of comatous state caused her unable to wean off the ventilator. During the nursing period (94/11/06~94/12/20), the author by using tools such as the Karnfsky scale, Barthel's scale, muscle strength test etc., with observations, physical assessment, communicational skills and Gordon's 11 functional health pattern to collect datas. The main nursing problems are as follow: 1.ineffective tissue perfusion/cerebral.2.ineffective airway clearance.3.impaired physical mobility. 4. caregiver role strain. During the nursing process, not only using professional knowledge and skills to caring the patient, but also using skills like leasoning and empathy to encourage the caregiver (her son) to express his feeling, and to instruct nursing techniques and to assist him look for helpful resources in order to overcome the family impact of the patient's conditions. Furthermore, to creat a positive attitude towards the responsibility of long term care. By nursing this patient, the author indicates while caring a patient we should also take notice of the caring of the main caregiver and provide discharge planning service, so as to provide holistic and high quality care.