一位心臟衰竭新住民之個案管理經驗

The Experience of Caring a New Immigrant with Heart Failure

本文描述協助一位50歲心臟衰竭印尼籍女性因應文化差異及面對身心壓力之個案管理經驗。照護期間2013/3/9-7/1，筆者運用羅氏適應模式並以觀察、會談、電訪及查閱病歷方式收集與分析資料得知因疾病影響身心，出現焦慮、無力感及不遵從行為等主要問題。透過個案管理介入，擬定個別措施，建立治療性護病關係，提升對疾病認知，減輕焦慮；提供可利用的社區資源，鼓勵用正向態度與行為強化溝通及社會互動，降低無力感；導正自我照顧知能，增進自信，建立健康行為，進而減少合併症與延緩病程，改善生活品質。面對臺灣新住民比例逐年增加，期能提供臨床此類個案之照護參考。

This article describes the experience of caring an Indonesian spouse with heart failure to cope with her frail physical condition and psychological stresses from cultural differences. The nursing period was between March 9th and July 1st 2013. The author collected information from observation, phone interviews and review of medical records. Roy’s adaptation model was also applied to evaluate the patient’s health problems. The problems identified included anxiety, feelings of powerlessness, and impaired compliance on self-care. Through case management intervention, individualized nursing measures were formulated to build the therapeutic relationship between the patient and the nurse to help the patient adapt to her disease and reduce her anxiety. Through utilization of community resources she developed more positive attitudes and behaviors’ communication and social interaction was improved with feeling less powerless. We also strengthened her self-care knowledge and ability to enhance self-confidence, cultivate healthy behaviors, thereby reduce complications and improve the quality of life. We share the case as a reference and hope it helpful for the nursing colleagues while dealing with similar cases. (Tzu Chi Nursing Journal, 2015; 14:3, 103-112)