探討首次腦中風病人初期之調適過程

Exploring the Primary Adaptation Process of First-Ever Stroke Patients

蔡惠如(Hui-Ju Tsai) ； 曾詩蘋(Shih-Ping Tseng) ； 王守玉(Shou-Yu Wang) ； 張瑛瑛(Ying-Ying Chang) ； 趙玉環(Yu-Huan Chao)

《護理雜誌》 63卷2期 (2016/04) Pp. 103-112

https://doi.org/10.6224/JN.63.2.103

摘要

背景　腦中風是全世界主要死因之一，在台灣位居十大死因之第三位，也是導致成人失能的主因，對初次中風病人的衝擊很大，其影響包含生理、心理及社會層面，目前國內對於探討首次中風病人於初期的調適過程較闕如。目的　本研究欲探索首次腦中風病人初期之調適過程。方法　採質性研究，以立意取樣，隨研究分析過程中，隨後進行理論性抽樣，共訪談十二位初次腦中風病人，並以紮根理論為研究方法及分析的方式，使用譯碼程序進行資料分析及統整。結果　本研究發現，首次中風病人初期的調適過程包含兩個範疇、六個次範疇及一個核心範疇，其分別為「中風的衝擊」：㈠失去身體自主權；㈡喪失自我價值；㈢難以承受，產生社交隔離。以及「中風後的因應」：㈠積極復健，重獲自主權；㈡家人支持，努力不成為負擔；㈢由苦難中昇華，轉趨正向概念。核心範疇為「面對中風，懷抱希望，人生就此改變」。結論／實務應用　研究結果呈現腦中風病人在初期調適過程的原貌，藉此提供臨床護理人員照護此類病人之參考，建議臨床上除了持續關注腦中風病人的初期調適外，更應針對病人在中風後因應過程中給予所需的幫助，並視其需求給予衛教及心理支持。

關鍵字

初次腦中風病人 ； 調適 ； 失能 ； 紮根理論 ； 質性研究

並列摘要

Background: Stroke is a leading cause of death worldwide and the third leading cause of disease-related mortality in Taiwan. Furthermore, stroke is a major cause of functional disability in adults, causing physiological, psychological, and social impacts. Little qualitative research has been conducted on the primary adaptation process of patients with first-ever stroke in Taiwan. Purpose: The present study explored the primary adaptation process of patients with first-ever stroke. Methods: This qualitative study used purposive sampling to enroll 12 patients with first-ever stroke for interviews, followed by theoretical sampling. Grounded theory guided the methodology and data analysis. Data analysis was performed simultaneously in accordance with the coding process. Results: The primary adaptation process used by the participants involved the two main categories of ＂impacts of stroke＂ and ＂adaptation after stroke＂, with three subcategories associated, respectively, with the former (loss of physical autonomy, diminishing perceptions of self-value, and stroke-related hardships turning into social isolation) and with the latter (regaining autonomy after rehabilitation, receiving support from family without being a burden, and release from suffering / becoming more positive). The core category that emerged from the present study was: ＂Facing stroke, hoping for the best, transforming lives.＂ Conclusions / Implications for Practice: The above findings on the primary adaptation process of stroke patients provide an important reference for clinical nurses / healthcare professionals who have responsibilities to care for patients with first-ever stroke. In addition, healthcare professionals should offer more health education and psychological support to stroke patients based on individual patient needs.

並列關鍵字

patients with first-ever stroke ； adaptation ； functional disability ； grounded theory ； qualitative research

參考文獻

岳端品、陳柚綾、陳淑齡（2010）．適應概念的分析．弘光學報，61，40–48。[Yueh, T. P., Chen, Y. L., & Chen, S. L. (2010). A concept analysis of adaptation. Hungkuang Journal, 61, 40–48.]

蕭如宜、王蓉敏（2012）．重建腦中風病患身體心像之護理經驗．志為護理—慈濟護理雜誌，11（3），87–98。[Hsiao, R. Y., & Wang, R. M. (2012). A nursing experience on restoring body image of a stroke patient. Tzu Chi Nursing Journal, 11(3), 87–98.

周雅璉、王錦雲、周寶鈺（2010）．協助一位初次罹患腦中風病人之護理經驗．新臺北護理期刊，12（2），111–120。[Chou, Y. L., Wang, C. Y., & Chou, P. Y. (2010). The nursing care experience of a patient who suffered from a first stroke. New Taipei Journal of Nursing, 12(2), 111–120.] doi:10.6540/NTJN.2010.2.012

解旻容、胡秀媛（2011）．照顧初次罹患腦血管意外病患之護理照護經驗．領導護理，12（2），45–57。[Chieh, M. J., & Hu, H. Y. (2011). A nursing experience of caring for a patient with cerebrovascular accident. Leadership Nursing, 12(2), 45–57.]

呂冠逸、黃翠媛（2014）．運用Mishel不確定感理論於初次中風個案之護理經驗．長庚護理，25（2），223–230。[Luang, K. Y., & Huang, T. Y. (2014). The application of Mishel's uncertainty theory in nursing experience for a first stroke patient. Chang Gung Nursing, 25(2), 223–230.] doi:10.3966/102673012014062502010