照顧一位因腦中風後長期臥床病人之居家護理經驗

Home Care Experience for a Bed-ridden Patient with Stroke

本文探討一位65歲因腦中風致長期臥床居家照護病人的護理經驗，依Gordon十一項功能健康型態，針對個案進行整體性評估。護理期間自2013年7月15日至12月16日，透過家訪、電訪，運用觀察、會談、身體評估及病歷查詢，在護理過程中因個案的疾病導致語言障礙，只能表達簡單字句故大部分多由案子和案媳的協助下進行資料收集與評估，確立病人主要護理問題為：潛在危險性感染、皮膚完整性受損、身體活動功能障礙。照護期間經由良好的互動和溝通與病人和家屬建立信任感，依個別性提供相關照護知識，衛教預防泌尿道感染的照護知識，讓照護者瞭解翻身技巧及傷口照護；教導照顧者被動復健運動技巧，維持病人肌肉力量和增進關節的柔軟和活動度，並協助提供輔具申請管道。另外，透過主動關懷及支持鼓勵建立病人及照護者自信心，也建議家屬未來持續為個案執行被動關節活動，並反覆觀看衛教光碟讓家屬更孰悉照護技巧，以提升個案照護和整體的生活品質。

This case report describes a home health care experience of caring a 65 years old patient who was long-term bed-ridden resulting from stroke. From July 15th to December 16th 2013, the author collected data through home visiting, observation, communication, physical assessment and history taking, as well as receiving information from patient’s son. . Gordon’s 11-item functional health pattern was applied to assess the patient’s problems. Three nursing problems were identified, including the risk of infection, impaired skin integrity, and impaired physical mobility. A mutual trust relationship was established through creating a good communication experience with the patient and family members during the nursing care. The caring knowledge was provided such as prevention of urinary tract infection, wound caring, and the technique of changing position. In addition, education was provided to help maintain patient’s muscle power to improve extremities and joints activities by performing PROM. Information about applying supportive devices was also provided. Caregivers’ and patients’ confidence can be enhanced through supportive systems and appropriate caring skills to release their pressure and anxiety so that the quality of life can be improved.