運用靈性照護模式於一位初次腦中風病人的經驗

An Experience Applying a Spiritual Care Model to a First-Time Stroke Patient

急性腦中風病人容易因身體功能障礙，而產生情緒低落與社交隔離，進而影響病人對疾病的調適並增加照顧者的負擔。護理人員大多重視對患者身體疾病的照護而易忽略靈性層面的關照。此份報告為筆者應用靈性照護模式護理腦中風個案之臨床經驗分享。個案是一位69歲的男性，退休鑿井工人，因急性腦中風而入院。筆者照護期間，個案發生急性意識混亂與神經狀態快速改變，之後又面對需依賴他人照護及復健效果不彰的衝擊。筆者運用靈性照護模式，以涵蓋自我、他人、信仰及自然環境間四個面向的關照，藉由會談、評估，確認個案因中風失去控制感，而出現沮喪、失去復健動機或感覺復健無效等現象。筆者予傾聽並建立信任關係，除提供疾病衛教以及滿足生理需求外，並提供正向鼓勵及支持，與其子女一同協助個案逐漸適應疾病所帶來的不便，並使其能積極參與復健。在此同時，筆者進一步強化靈性照護模式多向度的關係，使個案能由失望轉成希望，並進而提升自我照顧的動機與能力。期望此案例分析，提供照護人員了解初次腦中風病人的靈性需求及照護活動，滿足病人靈性需求，提升靈性照護品質。

Patients with stroke-related disabilities are at risk of depression and social isolation. This can make it difficult for the patient to cope with his or her disease and increase caregiver burden. While good at dealing with physical illness, nurses are often poor at attending to patients' mental and spiritual needs. In this paper, the authors introduce their experience using a spiritual care model to care for a stroke patient. The patient, a 69 year-old retiree, was admitted to our hospital due to an acute stroke. During hospitalization, he suffered from acute confusion and persistent focal weakness. His disability resulted in physical dependence, which did not improve during rehabilitation. We used a model of spiritual care and in-depth evaluation to identify several underlying psychological issues. These included feelings of hopelessness and loss of control and motivation. The authors established trust through active listening. In addition to standard nursing education and physical care, we, in cooperation with the patient's children, provided encouragement and support to help the patient cope with his disease burden and actively participate in rehabilitation. We applied a multi-dimensional spiritual care approach to help the patient shift from hopelessness to hopefulness. This enhanced his motivation to participate in rehabilitation and improved his self-care abilities. We hope this case report on the application of a spiritual-care model is useful reference for nurses responsible to care for stroke patients.