一位初次腦中風併肢體偏癱個案之案例報告

NURSING EXPERIENCE OF CARING FOR A PATIENT WHO FIRST SUFFERED CEREBRAL STROKE TOGETHER WITH LIMB HEMIPLEGIA

施怡如(Yi-Ju Shih) ； 江夏鋅(Shia-Shin Chiang) ； 黃思緯(Ssu-Wei Haung) ； 吳美娟(Mei-Chuan Wu)

《秀傳醫學雜誌》 19卷1期 (2020/06) Pp. 89-98

https://doi.org/10.3966/156104972020061901008

摘要

本文探討一位初次腦中風併肢體偏癱個案之護理經驗，於2018/07/23到08/16到運用Gordon十一項健康功能型態評估，經由觀察、會談及身體評估等方式蒐集資料，確立護理問題有身體活動功能障礙、潛在危險性跌倒、無望感。照護過程中，藉由主動關懷、傾聽及適時給予鼓勵等方式與個案及家屬建立良好護病關係；在身體活動功能障礙方面：運用跨團隊合作方式，與個案及家屬共同擬訂復建計畫，偕同家屬的支持及介紹復健成功案例分享，引導個案正向思考，持續復健，促使個案能維持最大肢體功能；在潛在危險性跌倒方面：指導日常生活照護技巧，降低跌倒的風險，避免再次傷害；在無望感方面：具體指出個案復健後肢體功能成效，激發個案復健的信心及希望，協助渡過無望感的危機，順利適應中風後的生活改變及提升其生活品質。經此照護經驗深刻了解心理安適是非常重要的，建議單位針對心理需求的評估及處置能力需持續的再教育，發揮護理獨特性，促使全人護理更加完善。再者臨床護理師及腦中風個案管理師的服務範圍，是個案出院後持續追蹤的一大限制，建議未來應建立無縫接軌的服務持續至居家的照護制度，以降低腦中風再入院率及合併症的發生率，期望此篇照護經驗可作為未來照護此類病人之參考。

關鍵字

中風 ； 無望感 ； 復健

並列摘要

This study explores the nursing experience for caring of a patient who first suffered cerebral stroke together with limb hemiplegia. The patient was assessed using Gordon's 11 functional health patterns, with the data collected through observation, interviewing, and physical assessments from July 23^(rd) to August 16^(th), 2018. The nursing problems identified included impaired physical mobility, risks for falls, and hopelessness. In the process of nursing, a good relationship with the patient and his family members was established through active caring, listening and timely encouragement. In terms of impaired physical mobility, the cross-team cooperation method was used to establish a rehabilitation plan with the patient and his family members, and through the family supports and the sharing of some successful rehabilitation cases, the patient was guided to think positively and continue to rehabilitate, thereby maintaining the best possible limb functions. In terms of risks of falls, daily care techniques were introduced to the patient to reduce the risks of falls and avoid reoccurring damages. In terms of hopelessness, the effectiveness of physical mobility after rehabilitation was specifically pointed out to boost confidence and hope of the patient toward the rehabilitation, thereby helping the patient overcome the crisis of powerlessness, smoothly adapt to the life changes after the stroke, and improve his quality of life. Through this caring experience, it is learned that having a deep understanding of psychological well-being is very important. It is recommended that the relevant nursing units should conduct continuous re-education on assessment of psychological needs and the handling ability as well as exerting the uniqueness of caring to further improve the holistic health care. In addition, the service scope of clinical nurses and cerebral stroke case managers is a major limitation of continuous follow-up after the patient is discharged. It is suggested that a seamless care system that is from the hospitals to the homes of the patients should be established in the future to reduce the re-admission rate of cerebral stroke and the incidence of comorbidities. This study of care experience can be used as a reference for future care of such patients.

並列關鍵字

Stroke ； Hopelessness ； Rehabilitation