輕度認知功能障礙長者其家庭照顧者負荷改善案例－－以家庭為基礎之個案管理計畫

Reducing the Care-Related Burdens of a Family Caregiver of a Person With Mild Cognitive Impairment: A Home-Based Case Management Program

認知功能障礙合併問題行為者之長期照護，會帶給家庭照顧者極大壓力與負荷。本文描述一位罹患多重慢性病的家庭照顧者，亦擔負照顧家中輕度認知功能障礙合併問題行為與藥物不遵從的先生。護理期間為2015年9月23日至2015年12 月29日，藉由家庭照顧者壓力理論評估其身、心、及社會負荷問題，運用以失智症家庭為基礎之個別式護理教育、照護技術訓練、傾聽與諮商及資源連結等介入措施，協助家庭照顧者減輕照顧負荷。以個別式家庭教育介入，評估主要照顧者需求及壓力源，確認護理問題為照顧者負荷過重，包含：照顧病人知識不足、藥物管理困擾、睡眠障礙、社會資源知識缺乏等方面壓力源。透過持續性關懷，建立信任關係，訂定照護需求的優先次序，分階段提供照顧知識、技巧，增進照護能力；藉由協助認識疾病與問題行為病程及藥物管理，提升認知與正向觀點，減少家庭衝擊；透過社會支持與長照資源的介入，協助照顧者增進生活品質，減輕照顧負荷。

The long-term care of cognitively impaired patients with concomitant behavioral problems brings great stress and burdens to family caregivers. The present article describes a family caregiver with multiple chronic diseases who concurrently shouldered primary care responsibilities for her husband, a patient with mild cognitive impairment, problematic behaviors, and medication non-adherence issues. The period of care was between September 23rd and December 29th, 2015. Data on physiological, psychological, and social burdens were collected based on a stress process model for family caregiving. We then applied a home-based, individually tailored intervention, which included nursing education, skills training, listening/counseling, and resource connecting, that effectively helped the family caregiver reduce her burdens. Our assessment identified nursing-care-related problems as the primary source of caregiver burden in this case, with identified stressors including a lack of knowledge regarding patient care, medication management problems, sleep disorders, and inadequate social resources. Using continuous care interactions, we established a trust relationship with the family caregiver, prioritized her needs, and provided dementia care knowledge and skills, which gradually improved her caregiving competence. Our instruction included increasing caregiver understanding of the disease course of dementia, related problematic behaviors, and medication management. Our intervention enhanced the disease awareness of the caregiver and helped her become more positive about her caregiving tasks. Therefore, the negative impacts on her family were reduced. Social support and long-term care resources further reduced her burden and improved her quality of life.