一位顱內出血病人復健期之中西醫結合照護經驗

The Traditional Chinese with Western Nursing Experience of Rehabilitation of a Patient with Intracerebral Hemorrhage

頭部外傷常見於顱內出血，除了會造成身體功能的改變，亦會影響病人身、心、社會各層面。本文係探討一位頭部外傷個案，因車禍導致顱內出血，手術行顱骨切開術(Craniectomy)後引發肢體功能障礙及身體外觀改變，於恢復期間介入中醫輔助療法協助復健之照護經驗，筆者於2008年10月23日至11月30日給予照護，期間藉由中醫整體性評估(望、聞、問、切），透過觀察、傾聽、會談及溝通等方式蒐集資料，確立個案有失眠、身體心像紊亂及無望感等主要護理健康問題。於護理過程中運用中醫護理，協助個案恢復信心以減少無望感並肯定自我，勇於接受肢體功能障礙及腦部手術後外觀之改變，及運用穴位按壓方式，協助個案解決失眠之問題，提昇其睡眠品質，鼓勵家屬共同參與，使個案能面對及調適顱骨切開術後所帶來的生理、心理、社會各層面問題，希望藉由照護此個案的護理經驗，提供臨床護理人員在面對照護類似個案之參考，以提昇護理照護品質。

Head injury with intracranial hemorrhage not only causes the changes of physical function but also affects the physical, psychological and social aspects of a patient’s life. This article focuses on a patient of head injury with intracranial hemorrhage which then led to dysfunction of extremities and changes of physical appearances due to the craniectomy operation. The patient performed traditional Chinese medicine complementary therapy to improve rehabilitation. The author performed Chinese holistic assessment (observation, listening, conversation, and communication) and emotional assessment from October 23 to November 30, 2008 and confirmed that the patient had the problems of insomnia, body image disturbance, and hopelessness. In the nursing process the author applied Chinese medical nursing to assist the case with rebuilding confidence, reducing hopelessness, and restoring self-affirmation, accepting extremity dysfunction and changes of physical appearances after brain surgery, and used acupressure method to solve insomnia and increase sleeping quality, encouraged family members to participate to make the patient confront and adopt the physical, psychological, and social problems due to Craniectomy. It is expected that this nursing experience can provide clinical nurses with a reference for caring similar patients and improve the nursing quality.