嚴重頭部外傷昏迷病人出院準備服務之照護經驗

Nursing Care Experiences of Providing Discharge Planning for Coma Patient with Severe Traumatic Head Injury

詹湘媛(Siang-Yuan Jhan) ； 何麗娟(Li-Chuan Ho) ； 黃月絹(Yueh-Chuan Huang)

《臺大護理雜誌》 14卷1期 (2018/01) Pp. 31-43

https://doi.org/10.6740/NTUHJN.201801_14(1).0005

摘要

本文描述照護一位35歲男性，於工作時從高處跌落致嚴重頭部外傷合併意識昏迷，其主要照顧者無法面對先生昏迷，對出院準備更是惶恐不安、甚至拒絕出院之護理過程。於2015/3/16至4/12經由直接照護、觀察、病歷查閱、家庭會議及提供出院準備服務過程，進行整體性護理評估，確認主要的健康問題包括呼吸道清除功能失效、自我照顧能力缺失及主要照顧者角色緊張。護理目標為減少昏迷造成的肺部合併症，給予個別護理指導，幫助主要照顧者能協助個案完成自我照顧；藉由家庭會議凝聚家庭共識；結合醫療團隊，幫助主要照顧者能取得相關的長期照護和社會福利資源，使個案順利出院。出院準備服務宜加強個案失能對家庭造成的衝擊，評估主要照顧者之負荷，同時轉介長照資源和社會褔利資源，使個案出院後能得到較佳的持續性照護。

關鍵字

出院準備 ； 頭部外傷 ； 照顧者角色緊張

並列摘要

This article described the nursing care experiences of a 35-year-old man with coma from severe traumatic head injury, after falling from a ladder. Nursing care also included his primary caregiver, who could not accept her husband's illness and felt so anxious about the future and therefore, she refused to have him discharged. Data was collected through direct care provision, including discharge planning services, observation, medical chart review, and the interviews with family members from 16 March to 12 April 2015. The ineffective airway clearance with a self-care deficit was identified as the patient's health problem, while the caregiver role strain was confirmed as the primary caregiver's issue. The individualized nursing care and education were provided to reduce the pulmonary complications of coma and enhance the primary caregiver's capacity to assist her husband with self-care. Moreover, nursing care involved multidisciplinary teams, facilitating discussions among family members, and helping the primary caregiver to obtain the resources regarding long-term care. The discharged planning service needs to emphasize the impacts of the patient's disability on the family and assess the burdens of the primary caregiver. Moreover, the assistance of referring long-term care service is needed to ensure that the patient continues to receive high quality of care after discharge from the hospital.

並列關鍵字

discharge plan ； traumatic head injury ； caregiver role strain