一位腦中風偏癱個案自機構返家之居家護理經驗

Home Hea1th Care Experience of a CVA Paralysis Patient First Retum Home from an Institution

本文描述一位71歲腦中風男性個案，初次自安養機構返家照顧之居家護理經驗。護理期間為2007年1月10日至2007年12月11日，共計11個月。筆者運用Gordon十一項健康功能型態做為評估架構，透過20次家訪及5次電訪方式，以觀察、身體評估、會談、傾聽及溝通等技巧完成資料收集，發現家屬從機構將個案接回家前，機構人員未提供足夠的照護指導，加上返家不久主要照顧者由家屬轉換為外籍監護工，照顧技巧不純熟導致產生潛在危險性感染、身體活動功能障礙，以及照護期間皮膚完整性受損等三項健康問題。在護理過程中，經由與個案及家屬的良好互動與溝通，提供正向的支持與鼓勵，透過加強預防感染、翻身技巧及肢體復健運動等護理措施，並協助申請及輔具運用，有效的促進壓瘡傷口癒合，且在無感染的情況下，將個案的尿管移除，進而增加個案關節的柔軟度及肢體活動功能，提升了個案的生活品質。希望藉此護理經驗提供往後照護此類個案的參考。This case report describes a home health care experience of a 71 years old client who first time discharged from an institution and returned home. From January 10 to December 11, 2007, through twenty home visits and five telephone intreviews, the Gordon's eleven-functional-health pattern was applied for assessment during the nursing process. As the institution did not provide an appropriate discharge plan before the patient returned home and the main caregiver changed to a never-met foreign care worker, three health related problems, including risk of urinary tract infection, impaired physical mobility and impaired skin integrity, were identified through direct nursing care, observation, physical examination, interview, listening, interaction and communication with the patient. With listening, empathy and positive supports in the nursing process, home health nurse provided direct nursing care, health education, consultant and information for the caregivers, and introduced the family to apply an assistive bed. Finally the client's urinary catheter was successfully removed. The pressure sore was recovered. The body activity functions and the quality of life were improved with the positive experience. It is hoped that this case report may highlight the importance of applying discharge plan in care institutions.