頭部外傷病患的出院準備服務：一病例報告

Applying Discharge Planning in a Family With a Head Injury Patient

本文係描述一位37歲的病患，為家庭主要經濟提供者，因車禍造成嚴重頭部外傷而陷入昏迷，整個家庭因而深受衝擊。當病人病況穩定醫師提到出院時，家屬更因缺乏後續照護資源而拒絕讓病患出院。在病患住院86天中，於出院準備服務過程，篩選病患並進行完整的評估，包括個案的醫療與照護需求、家庭的評估、社區資源的評估，發現主要的照護問題為：自我照顧能力缺失、照顧者角色緊張及家庭運作過程改變。筆者除了協助家屬探討完全失能病人對家庭的衝擊，並與醫療成員溝通、協調，整合現有的資源，提供照護諮詢，重整家庭成員的角色，終使家屬能面對病人完全失能的狀況且接受出院，而病人於出院後也能獲得妥善的後續照顧。

We present a 37 year-old male case who is the main economic provider of his family. He has sustained a severe head injury that makes him fall into deep comatose state. This episode impacts his family deeply. When the patient's condition becomes stable, the attending doctor will make the patient be discharged. The patient's families refuse to discharge because they lack of the resource of after care. During the 86 days hospitalization and the course of discharge planning, we screen and evaluate the patient. These process includes case's medical and care demand, family evaluation and community resource. Then we find the main care problems for this case are: self-care deficit, caregiver role strain and family process altered. In addition to help the family to realize the impact of a totally disabled patient to a family, we communicate with the medical staffs and integrate the present available resource. We also provide the patient's family the consultation of care and reunite the roles of the family members. Finally the family can adapt very well to the state of the patient's total disability and accept that the patient is discharged. And the patient has a good care after discharge.