運用不確定感理論協助一位首次上腸胃道出血之類血友病人其家屬之照護經驗

Applying Uncertainty Theory in Caring for the Family of a von Willebrand Disease Patient Experiencing First Time Upper Gastrointestinal Bleeding

本文描述一位類血友病合併厚皮性黏液水腫病人，首次出現上腸胃道出血，造成主要照護的家屬出現不確定感之照顧經驗。照護期間為2008年7月10日至7月18日，針對病人之疾病發展過程中家屬產生的不確定感問題，運用Mishel的疾病不確定感理論為架構，經由評估、觀察及會談完成行為過程紀錄，發現家屬(1)對於疾病的症狀及是否會復發產生不確定感、(2)缺乏疾病相關知識、(3)對於返家後腸胃道出血之居家照護產生不確定感等護理問題。在護理過程中利用「疾病不確定感量表」評估家屬不確定感的程度，以及提供其疾病症狀相關知識及心理支持等護理措施，以減輕家屬的不確定感，協助其返家後有能力繼續照護病人，並提高其照護品質。

The purpose of this report was to describe the nursing experience in helping a primary caregiver cope with uncertainty as his mother experienced upper gastrointestinal (UGI) bleeding underlying von Willebrand disease and Scleromyxedema in an Emergency Department between 10 and 18 July 2008. Mishel's Uncertainty Theory was applied to assess the caregiver's uncertainty and patient disease progression. Data were collected through clinical observation, chart review, and interviews. The caregiver's nursing problems were identified as (1) uncertainty caused by symptoms of the rare disease and the probability of recurrent bleeding in the future; (2) uncertainty caused by lack of knowledge about the disease; (3) uncertainty caused by lack of confidence in home caring issues after UGI bleeding. During the nursing period, we provided clinical information related to the disease and offered psychological support to the caregiver based on our Mishel's Uncertainty Scale assessment. Successful strategies utilized by our intervention helped the caregiver reduce level of uncertainty, increase confidence to care for his mother, and improve the quality of further home care.