照顧一位缺血性腦中風併失語症患者之護理經驗

The Nursing Experience of Caring for a Patient with Aphasia Caused by Ischemic Stroke

本文描述一位54 歲女性，因缺血性腦中風喪失語言能力而導致個案心理衝擊及焦慮之護理經驗。護理期間自2011 年8 月31 日至2011 年9 月9 日止。筆者藉由病歷查閱、訪談及運用Gordon 十一項功能性健康型態評估工具收集主客觀資料並分析，確認護理問題有1. 言詞溝通障礙、2. 吞嚥功能障礙、3. 焦慮、4. 身體活動功能障礙。在言詞溝通障礙方面：筆者與語言治療師討論後，與個案及家屬共同製作簡易溝通本，並與個案練習各式情境，讓個案一人時可與對方做簡單溝通；在吞嚥功能障礙方面：筆者結合營養師及家屬，了解個案之飲食習慣並依其所需提供飲食衛教及吞嚥能力運動訓練；3. 焦慮方面：照護期間以耐心、關懷的精神，與個案建立互信基礎，並經由支持系統的建立讓個案重拾自信心以降低其焦慮感；4. 身體活動功能障礙方面：筆者與復健師及家屬，共同制定每日復健計劃表，讓個案主動參與復健運動，並教導家屬各項照護技巧。透過跨團隊的合作模式，讓個案主動參與復健活動，提升個案日常生活功能，達到部份自我照護能力，維持日後良好的生活品質。因復健運動返家後仍需持續，建議復健團隊可將復健運動生活化，讓個案有更完整的後續照護。

This article described the nursing experience of caring a 54-year-old woman who suffered from mental shock and anxiety due to ischemic stroke. The nursing period was from August 31 to September 9, 2011. Data was collected by reviewing medical records and interview and then analyzed by Gordon's eleven functional health patterns assessment tool. Four health problems were found: impaired verbal communication, functional dysphagia, anxiety and impaired physical mobility. After discussing with language therapist, the author and the patient’s family made a cartoon book to help improve patient’s basic communication skills. Through understanding the patient’s eating habits, the author collaboratedwith nutritionist to educate the patient’s family about diet preparation and dysphagia rehabilitation The author tried to establish mutual trust with the patient, with patience and caring spirit. Besides, the patient was encouraged to regain self-confidence through support system to reduce her anxiety. The author, physical therapist, and the patient’s family created a daily schedule of rehabilitation for the patient to help her actively participate in rehabilitation program. In addition, we taught the patient’s family caring skills. In order to improve the patient’s daily living function and quality of life, we encouraged her to actively participate in rehabilitation through cross-team cooperation. The article suggested that rehabilitation team can integrate rehabilitation into patient’s daily activities in the hospital because it needs to be continually performed after discharge.