照護一位早發性失智症患者的護理經驗

The Nursing Care Experience of Caring for a Patient with Early Onset Dementia

本文為照護一位早發性阿茲海默型失智症患者的護理經驗，筆者於2012年1月12日至3月12日護理期間，運用Beck和Heacock（1988）之失智患者護理評估照護模式做為資料收集的指引，藉由會談、觀察、身體評估及病歷資料進行資料收集，經分析相關主客觀資料後，歸納個案有四個主要護理問題，包括焦慮、認知功能改變、潛在危險性跌倒及睡眠型態混亂。筆者藉由以全人為中心的照護，納入個案及案妻共同討論照護活動及目標，不僅可以維持個案自我感受和以往的日常生活型態，也可促進個案的自尊和自我價值。藉由認知功能訓練以維持及提升個案的記憶、定向感及現實感。藉由步態平衡感訓練及改善活動環境以提供個案安全的活動空間及預防個案跌倒。筆者透過陪伴、鼓勵及支持個案參與活動以增加社會化的參與、語言表達及自理能力。希冀本文之護理經驗能作為照護早發性失智症患者之參考。

This case report described a nursing experience of caring for an adult with early onset dementia. The nursing care period was from January 12 to March 12, 2007. Data were collected through interview, observation, physical assessment, and chart review. Patient’s physical, emotional, cognitive, and social status were assessed by the method by Beck and Heacock. The nursing problems included anxiety, change in cognitive ability, potential dangerous of falling, and disturbance of sleeping pattern. The principles of holistic and person-centered care were applied to engage the patient and his wife in discussing nursing care activities and goals, which included not only maintenance of the patient's feeling of self and his life style, but also improvement of patient’s self-esteem and self-value as well. Use of cognitive training can maintain and improve the patient’s memory, orientation, and sense of reality. Gait balance training and better environment arrangement offered the patient a safe space and prevented him from falling. The primary nurse provided the patient with companionship, encouragement, and support to improve his social involvement, language expression, and self-care ability. We hope this nursing care experience could provide nurses with a reference for caring patients with early onset dementia.