以歐倫自我照顧理論照護一位獨居腦中風患者之護理經驗

Nursing Experience in Applying Orem's Theory to a Stroke Patient Living Alone

本文是探討一位56歲獨居腦中風個案，因酒醉溺水就醫後診斷為二度中風導致右側偏癱，導致日常生活無法自我照顧，筆者於2008年4月25日至6月1日照護期間，運用歐倫(Orem)自我照顧理論藉由傾聽、觀察、會談、身體評估進行資料收集及評估個案，確立個案呈現的健康問題有呼吸道清除功能失效、身體活動功能障礙、自我照顧能力缺失、焦慮等四項健康問題。經由護理系統之完全代償、部份代償、支持教育性護理概念提供相關護理措施，包括教導用力呼氣技巧加上哈氣動作以達有效鬆動及清除痰液，協助適當的姿勢擺位及關節運動改善肢體活動障礙，教導個案學習日常生活自我照顧的方法，此外與社工共同提供獨居個案的照顧及支持系統以減輕焦慮感受。期望藉由此篇個案報告的護理經驗分享，提供護理同仁照護相關個案之參考。

This article describes a 56-year-old stroke patient who lived alone. After getting drunk and then almost drowning, he was diagnosed with a second stroke, resulting in right hemiplegia. During the nursing period from April 25 to July 1, 2008, the author collected data by listening, observing, and interviewing, as well as through physical assessment. The purpose was to study whether the patient’s nursing care needs could still be addressed after suffering from the stroke. The patient’s health problems included ineffective airway clearance, impaired physical mobility, a deficiency in self-care, and anxiety. Through the nursing system, complete compensation, partial compensation, and supportive-education were effectively applied to teach forceful exhalation skills accompanied by blowing so as to cough out phlegm. Assistance with proper posture positioning and joint movement decreased limb disability. Offering an education in health, furthermore, enhanced the patient’s day-to-day care abilities. In addition, collaborating with social workers provided health care resources, as well as a proper support system, to the case and reduced the patient’s anxiety. This report is expected to provide first-hand nursing experience as a reference for nurses who care for similar patients.