中部地區居家照護病患之復健治療需求

The Role of Rehabilitation in Home Health Care of Taichung Area

賴慧貞(Huey-Jen Lai) ； 徐弘正(Horng-Jeng Shyn) ； 潘文弘(Wen-Hong Pan) ； 吳坤霖(Kuen-Lin Wu) ； 許國敏(Kuo-Ming Hsu)

《中華民國復健醫學會雜誌》 20期 (1992/12) Pp. 99-104

摘要

本研究收集台中市護理師護士公會居家護理自民國78年10月至民國80年12月之所有個案，分析其性別、年齡分佈、主要照顧者、疾病別；居家護理師接案方式、提供之服務項目及其預後。並設計問卷針對台中地區從事居家護理工作之護理師，調查其訓練背景、所接個案疾病別及其比例、復健治療服務項目之勝任度、期望之復健護理訓練、期望之復健治療資源及患者可能無法接受居家復健治療服務之原因。
171位接受居家照護服務之個案中，年齡層以70至80歲為最多，佔32.3%；而60至90歲則共佔70.8%。疾病別則以腦中風最多，共83例；癌症未期患者計34例。服務項目以簡易復健治療最多，佔105例：插鼻胃管95例、插導尿管77例，亦為主要服務訴求。其接案方式以醫院轉介為主，共132例。主要照顧者以子女(91例)及夫妻的另一方(60例)為主。其中107例可維持疾病穩定或進步，有59例死亡，5例因併發症入院。
從事居家照護之護理師訓練背景各異。除衛生署舉辦二個月之居家護理職前訓練，極少有2個月以上之復健護理訓練者，但陸續有因工作需要的在職訓練，使她們能從事簡易復健治療。多半護理師希望再接受由口進食訓練、解尿訓練及日常生活訓練的課程。這類患者可能無法接受居家復健治療較重要的因素依次為：家屬無法配合、經濟問題、無復健價值，最後才是患者拒絕。護理師尚提出另一重要因素：患者無法找到居家復健治療資源。由此研究，顯示居家照護有相當大的復健治療需求，若能得到保險給付，更能提高其可行性。另一方面，訓練居家護理師具備相當程度的復健治療知識，不但能提昇照護品質，而且有助於復健專業人員的介入。

關鍵字

居家護理 ； 年齡 ； 主要照顧者 ； 疾病別 ； 服務項目 ； 復健治療

並列摘要

All cases of home care under the service of the Nurse Assiciation of Taichung City from Oct. 1989 to Dec. 1991 were collected to evaluate sex, age distribution, major caretaker, main disease entities, referral source, service items and prognosis. Questionaire was made for home care nurses of Taichung area to evaluate their training back grounds; disease items of clients and the percentage of the individial items; rehabilitation items that they think they could do, want to learn to do and hope the involvement of rehabilitative specialists; and the major causes interfering the receivement of rehabilitative home care.
In 171 cases collected, the major age distribution range was between 70-80 year-old (32.2%); 70.8% of cases was between 60-90 year old. The main disease entities were cerebral vascular accident (83 cases) and terminal stage of cancer (34 cases). The m3or service items were simple rehabililitative exercise (105 cases), on nasogastric tube (95 cases) and on foley (77 cases). The majority of cases (132 cases) was referred from hospital. The major caretakers were son, the wife of son and/or daughter (91 cases) and the client's partner (60 cases). Stabilization or improvement could be found in 107 cases. 59 case resulted in death. There were 5 cases readmitted due to the complications of disease.
The training back grounds of home care nurses were variable except two months of preoccupational training. No nurse had recived more than two months' rehabilitation training. They learned simple rehabilitative techniques from symposiums done later during occupation, and still wanted to learn more techhniques about feeding, bladder and activities of daily living training. The major etiologies that their clients could not receive rehabilitative home care were: family cause, disease severity and patient refusal, in order. The another etiology provided by nurse was: no available source of rehabilitative home care.
In one word, rehabilitative potential of home care has its developmental space, especially if supported by medicare, medicad and other insurrance. Training of rehabilitative nursing could not only improve the quality of care, but also help the involvement of rehabilitation specialists.