協助一位居家護理病人胃造瘻決策過程之經驗

Home Care Nursing Experience of the Decision Making Process for Percutaneous Endoscopic Gastrostomy

本文探討一位因長期留置鼻胃管而併發反覆胃出血及身體心像改變的中風病人，在居家護理師的協助下決定接受胃造瘻手術之護理過程。自92年5月29日至93年3月1日收案期間，在20次病房探視、5次家訪、30次電訪中，居家護理師運用Gordon十一項健康功能型態評估，藉由直接護理、觀察會談等方式收集資料，分析病人的健康問題包括：身體活動功能障礙、潛在危險性傷害、身體心像改變。護理過程中運用傾聽及同理心給予病人和家屬正面支持，提供諮詢及相關資料並介紹成功之案例，讓家屬及病人對胃造瘻有更深一層的認識，終於使病人及家屬突破維持身體完整之傳統觀念，成功執行胃造瘻手術，對疾病過程有正向之經驗感受。

This case study explored the home care nurse’s role in helping a stroke patient, who had complications whilst using a nasogastric tube, to decide whether to have percutaneous endoscopic gastrostomy (PEG). From May 29, 2003 to March 1, 2004, the home care nurse assessed the patient using Gordon's 11 functional health patterns during five home visits, 30 telephone interviews and 20 hospital bedside visits. Three health related problems were identified through direct nursing care, observation and interviews. These were: impaired physical mobility, potential for injury and changed body image. By listening, and showing empathy and positive support during the nursing process, the home care nurse provided consultation and information. This helped the patient and his family finally break the traditional concepts of body integrity and decide to agree to have PEG surgery, with positive results.