以結合輔具的溝通方式降低額顳葉失智症病人躁動之護理經驗

A Nursing Experience Using the Props-Integrated Communicative Approach to Ameliorate Aggression in a Frontotemporal Dementia Patient

本文是照顧一位溝通表達障礙的額顳葉失智症病人之護理經驗。個案因罹患額顳葉失智症，出現語言表達障礙，並因躁動行為，致照顧負荷沈重而入精神科急性病房接受治療。護理期間為2012年3月5日至2012年4月30日。筆者運用五大層面整體性指引與相關量表進行評估，發現三個主要健康問題：言辭溝通障礙、慢性混亂、照顧者角色緊張。本報告中之護理過程，主要著眼於個案的言辭溝通障礙問題。筆者運用溝通輔具結合溝通策略，設計適合個案的溝通模式，以促進表達及溝通，進而改善躁動行為；並將此溝通模式教導給家屬，藉此提升照護能力且緩解負荷。建議於照護額顳葉失智併溝通障礙病人時，可參考本報告經驗，將溝通輔具運用於溝通策略之中，設計合適的溝通模式，以提升照護品質。

This report introduces the nursing caring experience with a male patient with frontotemporal dementia (FTD) who was hospitalized in an acute psychiatric ward from March 5th to April 30th, 2012 due to the clinical manifestations of verbally expressive impairment, aggression, and subsequent caregiver burden. The patient was assessed according to the guidelines of clinical competencies for mental health nursing assessments developed by the Psychiatric Mental Health Nurses Association. Three clinical diagnoses were identified after this assessment, including (1) impaired verbal communication, (2) chronic confusion, and (3) caregiver role strain. The current report focuses only on the clinical issue of impaired verbal communication. We adopted a props-integrated communicative approach by integrating props and physical motions with communicative strategies. This approach enabled us to formulate a patient-centered communicating model and prompt for active expression and adequate communication, which ultimately resolved the patient's aggression problem. In addition, we provided psychoeducation to the family members in order to teach them the relevant knowledge, skills, and approaches that caregivers may use to enhance their caring capabilities and reduce the burden of caregiving. This successful experience may be used as a reference in caring for FTD patients with communicative impairments. Our proposed approach integrates props with simple language and develops an appropriate communicating model to provide high quality care for patients.