一位腦中風合併紫色尿袋症候群之居家護理經驗

An Experience Providing Home Care to a Victim of Cerebral Vascular Accident and Purple Urine Bag Syndrome

本篇報告以照護一位長期放置導尿管之腦中風個案，於居家期間因家中成員認知的缺乏、照顧技巧不一及缺乏溝通、人力支持，致個案尿袋出現紫色，主照顧者出現身心疲憊與擔憂，造成整個家庭因應能力降低。在護理期間95年3月10日至95年8月15日共訪視10次、電訪8次，護理評估中發現個案有：現存性泌尿道感染、便秘、妥協性家庭因應能力失調等三項護理問題。因與案家建立信任關係，對個案所焦慮的紫色尿袋問題提供持續、計劃性的護理活動，最後同時解決尿管留置無感染、便秘等問題，使家庭的功能穩定，讓生病老者能持續在家受照顧，並突顯居家護理獨特性功能。經此特殊個案的探討，發現衛生教育須定期追蹤以能維持良好成效，但在處理病人家庭問題時，仍感會談技巧不足，建議在臨床護理訓練能安排相關課題並實際演練，以增進護理人員處理病人家庭問題的能力，並提升個案生活品質。

This article presents the case of a victim of cerebral vascular accident with long duration of urinary catheterization, who developed a purple urine bag syndrome (PUBS) because of deficiency of knowledge and skills in home care and lack of communication and support among family members. In this case, the main caregivers also experienced psychophysical fatigue and fear, which diminished family coping ability. During the period of nursing care, from March 10 to August 15, 2006, we carried out 10 home care visits and eight telephone consultations. Exiting urinary tract infection, constipation, and compromised coping and ineffective family were identified as the three main nursing care issues. As we successfully instilled trust and developed a positive relationship with the patient, we provided continuous and comprehensive nursing care to resolve the PUBS issue her which was causing her anxiety, and her constipation, as well as stabilizing her family function. Consequently, through this care experience involving a sick elderly patient, we promoted the function of nursing home care. From this case intervention, we found that health education should be closely followed up in order to maintain its effectiveness. Insufficient communication skills, however, were identified through meetings with the patient's family. We suggested related family communication skills and practices should be included in clinical nursing training courses to enhance skills in dealing with family issues and life quality among patients and their families.