運用羅氏適應模式照護一位失智症患者之臨床經驗

An Application of Roy's Adaptation Model to Care of a Dementia Patient

隨著人口老化，失智症就像銀髮族的流行病，有不斷增加的趨勢。民國89年臺灣的失智症盛行率佔2～4%，而且還在不斷上升當中。失智症造成患者生理功能的癱瘓、心理引起不當的情緒和行為，以及社會功能的退化等，都會形成照顧者的壓力，也造成社會沉重的負擔。本文旨在探討失智患者在疾病過程中所面臨的問題，藉由羅氏適應模式探討個案的生理、心理和社會功能，分析個案有思想過程改變和個人因應能力失調等問題，期望經過護理措施如建立信任感、瞭解個案的感受、教導溝通和鬆弛技巧、提升個案的現實感及增進個案有效的適應，俾能改善其生活品質及延緩病程發展。結果個案可以在協助下接受現實狀況，面對不愉快的事件不再以哭泣、憤怒和漫罵的方式表現，同時能主動找人溝通，適當表達自己的想法，和他人良性互動增加，進而提升個案的生活品質。

Dementia is showing an upward trend as the number of elderly people increases. The incidence rate of dementia in Taiwan increased from 2% to 4%; a further increase is predicted. Persons with dementia often experience a reduction in physical functions, psychological emotional inappropriateness, and impaired social function. Subsequently, the burden of caregivers and society may increase. The purpose of this case study was to use Roy's adaptation model to understand the problems related to physical, psychological, and social functions that occur during disease processes in a female patient with dementia. A trust relationship was established during nursing intervention. Understanding the woman's feelings, teaching her relaxation skills, improving her sense of reality, and increasing her effective adaptations were interventions used to improve her quality of life and to delay the progression of the dementia. Findings indicated that the woman was accepting the fact that she had dementia. Prior to interventions, she cried, displayed anger, and cursed. By contrast, after implementation of the interventions she was able to engage in two-way conversations, express her ideas, and establish positive relationships with others. Finally, her quality of life improved.