運用關懷理論照護一位創傷性顱內出血術後病人之護理經驗

Applying Caring Theory on a Traumatic Intracranial Hemorrhage Patient after Surgical Treatment

蔡旻潔(Min-Jie Tsai) ； 蔡蕙如(Hui-Zu Tsai)

《高雄護理雜誌》 36卷1期 (2019/04) Pp. 67-78

https://doi.org/10.6692/KJN.201904_36(1).0007

摘要

本文描述一位創傷性顱內出血個案術後於加護病房照護的經驗，於2017年2月6日至19日透過身體評估、觀察、會談等方法收集資料，進行生、心、靈、社會之整體性評估，發現個案有腦組織灌流改變、身體活動功能障礙、焦慮之健康問題。在照護過程中，提供個別性護理措施，維持生命徵象穩定，沒有顱內壓升高之徵象；對於疾病導致的身體活動功能障礙，以及肢體偏癱產生的焦慮情緒，運用Swanson理論了解個案之想法及需求，協助其面對疾病帶來的衝擊，緩解其焦慮的情緒，引導正向情緒發展，鼓勵積極參與復健計畫，早日恢復原有之生活。建議未來除了生理層面評估外，可透過家庭支持系統和跨團隊領域合作協助類似個案儘早參與復健活動，早日恢復原有生活軌道。

關鍵字

顱內出血 ； 身體活動功能障礙 ； 焦慮

並列摘要

This report describes the nursing experience and care of a traumatic intracranial hemorrhage patient after surgical treatment in ICU. The authors collected data through physical assessment, observation, and interview from February 6th to 19th, 2017. A comprehensive assessment of the patient's physiological, psychological, social and spiritual states was noted and used to identify health concerns including ineffective cerebral tissue perfusion, physical activity dysfunction, and anxiety. During the nursing period, individual nursing care was provided to maintain a normal range of vital signs and intracranial pressure. Utilizing Swanson's theory, the authors assisted the patient in adjusting to the impacts of impaired physical mobility and hemiplegia according to his feelings and needs, and then relieved his anxiety. The authors led the case to improve positive attitude development and encouraged him to take an active participation in the rehabilitation treatments. The study suggests that the cooperation between family support and multi-medical teams can help similar cases to participate in rehabilitation treatments, besides developing the physiological aspect assessment and thus recovering a normal life as soon as possible.

並列關鍵字

intracranial hemorrhage ； physical activity dysfunction ； anxiety

參考文獻

林素玉、周翠蓉、陳蕙玲(2012)‧照顧一位車禍導致頭部創傷引發蜘蛛膜下腔出血個案之加護護理經驗‧澄清醫護管理雜誌，8(2)，45-53。

黃寶、王仁宏、樊志成、梁忠詔、林書蔓、楊士賢(2015)‧創傷性腦傷患者亞急性期復健療效之分析‧台灣復健雜誌，43(3)，171-179。

De, D., & Wynn, E. (2014). Preventing muscular contractures through routine stroke patient care. British Journal of Nursing, 23(14), 781-786.

Kumar, R., Singhi, S. C., & Singhi, P. (2012). Raised intracranial pressure(ICP): Management in emergency department. The Indian Journal of Pediatrics, 79(4), 518-524.

Kukreti, V., Mohseni, B. H., & Drake, J. (2014). Management of raised intracranial pressure in children with traumatic brain injury. Journal of Pediatric Neurosciences, 9(3), 207-215.