照護一位中年期因腦缺氧長期臥床個案之居家護理經驗

Home Care Experience for a Long-Term Bedridden Patient post Cerebrovascular Ischemia

本篇個案報告乃描述筆者照護一位因腦部缺氧長期臥床個案之居家護理經驗。自2007年02月16日至2007年05月28日，筆者共居家訪視4次及電訪案家4次，運用Orem自我照顧理論模式評估個案，其日常生活均完全依賴其越南籍之看護工。筆者於居家訪視時以實際觀察法及與該看護工會談收集資料，另依自行設計之「居家護理指導評值單」評估看護工對個案之照護狀況，發覺個案有下列護理問題：1．呼吸道清除功能失效－氣管內管內分泌物過量；2．保護能力改變－氣切管路感染∕照顧者技術不正確；3．特殊照護知識及技能缺失－對抽痰、更換氣切內管∕缺乏相關資料來源；4．照顧者角色緊張∕對照護層面不熟悉。筆者利用家訪機會給予適切的居家照護及護理指導，並評值其照護成效，最後再依其實際作業需求修訂筆者對看護工之護理指導內容，希望此經驗能提供居家護理師未來照顧此類病人之參考。

This case study described the author's home care experience of a long-term bedridden atient post cerebrovascular ischemia. During the period from February 16 to May 28, 2007, the author, using Orem's theoretical pattern of self-attendance, appraised the patient's activities of daily life through four home visits and four telephone interviews with the Vietnamese caregiver. Direct observation and interviews were used for data collection. In addition, a form was designed to evaluate the home care provided by the caregiver. The finding included (1) ineffective clearance of the tracheostomy inner tube - excessive accumulation of secretion; (2) alteration of the protective ability of the trachea tracheal infection due to incorrect suction technique; (3) lack of nursing knowledge, lack of skills in tracheostomy suction and replacement of the tracheostomy inner tube, and lack of the resource of nursing care; and (4) the caregiver's anxiety in her role-unfamiliar to nursing care. The author provided appropriate home care and nursing guidance and evaluated the outcomes of the nursing interventions during home visits. Finally, the author revised the contents of the nursing guidance based on the actual operational needs. The author hoped that this experience might be shared with the home care nurses who care for such kind of patients in the future.