運用Watson 理論於老年腦中風無望感患者之護理經驗

Application of Watson’s Theory in Caring of an Old Stroke Hopelessness Patient

本文描述一位老年婦女初次罹患腦中風患者，因左側橋腦血管梗塞導致右側肢體乏力，提供關懷照顧與身、心、社會、靈健康之全人照護經驗。筆者於2013年3月18日至23日照護期間，藉由會談、傾聽、觀察及身體檢查評估等方法收集個案身、心、社會及靈性等健康資料。確立主要健康問題共五項，包含身體活動功能障礙、自我照顧能力缺失、特定的知識缺失、無望感以及潛在危險性跌倒。藉由Watson理論關懷照護因子為照護架構，透過關心、傾聽、陪伴、同理、支持與鼓勵等，與個案建立良好且信任的治療性人際關係，並提供安全且隱私的照護環境。在互動中運用同理心，鼓勵個案正負向感受表達。介紹復健成功案例、轉介復健、社工及出院準備服務等，共同協助面對腦中風後遺症所帶來的影響，增進個案對治療的信心與希望，以致持續復健與正向社交互動。最後改善個案的身體活動功能障礙及無望感，增進自我照顧之正確認知與技能。而運用Watson關懷理論照護，能有效協助老年個案走過腦中風帶來的無望感。希望藉本文照護經驗，體認個案身、心、社會、靈的問題與需求，作為日後類似個案之全人照護參考。

This case report described the holistic health care experience from 3/18/2013 to 3/23/2013 to an elderly female patient who suffered from left pontine infarction with right hemiplegia and faced physical dysfunction The author collected four aspects of health information through interview, listening, observation, and physical assessment. It was identified that the patient had several nursing problems, including impaired physical mobility, self-care deficit, knowledge deficit (diet and rehabilitation), hopelessness, and potential risk for falls. The nursing care comprised the application of Watsons theory with full empathy, to establish a good nurse-patient relationship, to provide a safe and privacy care environment, and to encourage expression of positive and negative feelings. The author helped the client to improve physical function impairment, hopelessness, and self-care ability through introducing other successful cases, involving physiotherapy, discharge services and social worker, and regaining confidence toward rehabilitation and positive social activities. The author shared this nursing experience and hoped it could be used as a reference for the nurses taking care of the patient with stroke in the future.