運用Mishel不確定感理論於初次中風個案之護理經驗

Application of Mishel’s Uncertainty Theory in Nursing Experience for a First Stroke patient

此篇敘述一位53歲首次中風女性，因右側肢體偏癱，使患者失去執行日常功能能力，且表達出對罹病原因的歸因行為。筆者於照護期間2011年8月9日至2011年9月7日完成5篇行為過程實錄，並配合會談、觀察、身體評估與檢驗數據分析結果，在Mishel不確定感理論架構下發現個案不確定感，包括對疾病認知不足及對肢體復原的不確定感，藉由護理過程的介入，設定個別性目標，運用傾聽及陪伴技巧，建立治療性關係，提供個案疾病相關知識，澄清其錯誤觀念，鼓勵個案持續復健，並具體指出個案復健後肢體功能成效，適時給予讚美，增進患者自信心，進而提升復健的意願，有效降低個案不確定感，進而成功面對疾病與後續的復健。期能分享此照護經驗給其他醫護同儕，有助於臨床病人照護。

This case report described the nursing experience of a 53-year-old female with first stroke, who was hospitalized from August 9, 2011 to September 7, 2011. The patient suffered from right side hemiplegia caused by stroke, resulting in the impairment of her ability to function on activity of daily lives. She also displayed uncertainties with expressive morbidity attribution behaviors. Mishels’ Uncertainty Illness theory was applied as a framework for interviews, observations, assessments as well as data analyses. Through which, patient’s uncertainties toward the perceptions of illness and limbs recovery were identified. As a result, individualized nursing goals were established. A therapeutic patient-nurse relationship was then developed via attentive listening and companionship. Over the course of treatment, the subject was provided with correct stroke knowledge in order to avoid any further misunderstandings. Timely praises were used so that she could stay motivated in limbs rehabilitation. In the end, the authors noted significant reduction in patient’s uncertainties. This case report aimed to share precious nursing experience with other practitioners in the same field.