運用家庭復原力模式照顧頭部外傷患者家庭之護理經驗

The Application of the Resiliency Model to Caring for the Family of a Head Injury Client

頭部外傷多事發突然，且病患病情又嚴重，故此事件常造成家庭危機的出現，國內外多有文獻探討頭部外傷造成家庭的負荷與需求，本文旨在運用家庭復原力模式來評估一個家人突遭頭部外傷家庭之調整過程與需求，進而協助其在過程中有良好的調適結果。筆者自91年6月26日至7月10日擔任主護護士，藉由觀察、會談、與家人及其公司同仁互動來收集資料，經採用復原力模式中影響家庭調適之五大因素評估後，此家庭的主要壓力源有：先生頭部外傷住院預後不明、家中目前無經濟來源、和不知如何向小孩解說父親病情；主要的家庭護理問題為：家屬對頭部外傷病情與治療之知識缺失、妥協性家庭因應能力及家庭運作過程紊亂等。筆者藉由衛教、家庭會談、角色扮演及遊戲方式等護理措施，引導家屬對疾病治療有正確的認知，參與患者之復健計劃；最後，家屬能運用內外在資源有效的解決問題，安然的渡過此疾病危機。本研究結果顯示復原力模式適用於評估處於危機狀態之家庭，並作為協助家庭導向調整良好照護之依據。

Head injury often occurs in accidents, with severe consequences affecting not only the injured individual but his/her entire family. The purpose of this paper is to describe a case of nursing care provided to the family of a head injury patient using the family resiliency model. From June 26 to July 10, 2002, one of the authors took care of the head injury patient as a primary nurse, then assessed the family in accordance with the five factors influencing the family crisis adaptation process identified in the family resiliency model. The major stressors for the family included the unknown prognosis for the patient, the lack of family income, and not knowing how to talk with the children about their father's condition. Three nursing problems were identified, as follows: the family's knowledge deficit concerning head injury treatment, compromised family coping, disruption of family life and lack of coping resources. Applying various nursing interventions (i.e. education, family conferences, and play therapy), the authors guided the family towards an understanding of the disease treatment plan and the stresses they were facing. Finally, family members were able to participate in the rehabilitation plan for the patient and to find the resources to solve the family problems. This demonstrated that the resiliency model is a good tool for assessing families in crisis and planning nursing care in order to facilitate the family's successful bonadaptation.