照顧一位神經性膀胱患者排尿障礙之護理經驗

Nursing Experience of Caring for Urinary Disorder in a Neurogenic Bladder Patient

本文為照顧一位26歲女性因神經性膀胱出現解尿困難，面臨導尿管留置之護理經驗。護理期間由2017年12月1日至2017年12月15日，透過直接照護、觀察、會談及身體評估收集資料，運用Gordon十一項功能性健康型態進行整體性評估，確立個案有排尿型態障礙、潛在危險性感染及無望感三項護理問題。在護理過程中，教導凱格爾運動與膀胱訓練，及利用留置導尿管改善排尿問題；透過教導每日導尿管照護、正確洗手方式、飲食衛教，教導如何辨識感染症狀預防泌尿道感染發生；採取主動關懷建立良好護病關係，以主動關懷的態度鼓勵個案表達自我感受，適時給予正向回饋及家庭成員支持，使個案能正向思考並積極參與自我照護與訓練，降低其無望感，進而讓個案能提升生活品質早日回歸正常生活。建議在照顧此類病人時，衛教內容可運用多媒體工具強化病人正確照護知識以降低感染發生，主動提供出院準備服務，結合居家照護及後續門診之聯繫，給予整體性照護。（澄清醫護管理雜誌2020；16（3）：45-54）

This paper examines the nursing experience of caring for urinary disorder in a 26-year-old female neurogenic bladder patient. During the care period (1 December 2017 to 15 December 2017), data were collected through direct care, observation, interviews, and physical assessment. Gordon's 11-item Functional Health Pattern was used for comprehensive assessment and confirmed the following three care problems in the patient: urinary dysfunction, potentially dangerous infections, and hopelessness. During the nursing process, Kegel exercises and bladder training were taught, and indwelling urinary catheters were used to improve micturition. Daily catheter care, proper hand washing techniques, dietary education, and the identification of infection symptoms were taught to prevent urinary tract infections. Proactive caring was used to establish a good nurse-patient relationship, and the patient was actively encouraged to express her feelings. Appropriate positive feedback and support from family members were provided to the patient in order to encourage positive thoughts and active participation in self-care and training, which help reduce hopelessness. This enabled the patient to improve quality of life and return to normal life as soon as possible. It is recommended that, when caring for similar patients, multimedia tools be used for health education to strengthen the patient's correct care knowledge to reduce the incidence of infection and discharge preparatory services should also be proactively provided. This can be combined with home care and follow-up outpatient consultations to provide comprehensive care. (Cheng Ching Medical Journal 2020; 16(3): 45-54)