照顧一位無望感老人之居家護理經驗

Home Care Experience of Caring for an Elderly with a Sense of Hopelessness

本文探討一位自2015年跌倒後長期臥床居家個案，期間因缺乏足夠家庭支持系統及正確照護技巧，導致身體功能退化及歷經壓瘡的產生，而出現情緒低落、被動、表情淡漠，不願進食等消極行為之無望感老人居家照護經驗，故讓筆者想進一步瞭解協助改善現況。照護期間為2016年11月4日至2017年4月26日，以實際回覆示教、會談、觀察方式等運用老人周全性評估收集資料並彙整分析，發現個案主要健康問題如下：一、無望感；二、皮膚完整性受損；三、照顧者角色緊張。照護期間，與家屬共同擬訂個別性之護理措施，執行護理措施前先傾聽內心想法並運用關懷及同理心，透過定期電訪及通訊應用軟體傳遞傷口之狀況，鼓勵家屬接受個案正常無望感之反應，建議外籍照顧員可觀看當國電視節目，以緩解身心壓力等等。收案過程中，依個案及主要照顧者提供適切、個別性照護計畫，其具體成效有：一、案子共同參與擔任照護個案的責任及溝通橋梁；二、提升非語言溝通技巧與能力；三、有效提升個案照護品質；四、提供印尼版照護技能衛教單張圖片及影片等，改善了個案由口進食之意願、增進身體活動之功能、壓瘡傷口之癒合進而提升個案之生活品質，維持家庭之完整性。

This article presented a nursing experience of caring a bedridden elderly man who fell down in autumn 2015. This patient's hopelessness presented as depressive and passive emotion, straight face, and aphagia. These negative behaviors came from physical disability and pressure sore which caused by insufficient family supportive system and incorrect care skills. The nursing care period was from Nov, 4, 2016 to Apr. 26, 2017. The methods included exampling physical characteristics, discussions, and observations. After data analyses and a complete evaluation, the main health problems were listed below: 1. a sense of hopelessness, 2. impaired skin integrity, and 3. tensions in health caregiver. The family and I made individualized nursing care policies during this period, including listening to patient's inner thoughts, expressing concerns and sympathy of caregivers before nursing procedures, conducting routine telephone interviews, observing wound conditions by a communication media, encouraging his family to accept this patient's distressed mood, providing a relaxing program for his foreign caregiver by offering home country television programs and providing a series of nursing care skill pictures and videos in Indonesian. The major outcomes included: 1. enabling the patient's son cooperate as a competent care giver and a bridge for interpersonal communication, 2. promoting nonverbal communicational skills and abilities, 3. providing an effective plan to improve care quality, 4. improving willingness to food intake, increasing physical activities, and facilitating pressure sore healing processes, and thus enhancing the quality of life and family completeness of the patient.