一位再次腦中風病人因應疾病過程之護理經驗

Experience of Nursing a Patient with Recurrent Stroke

本文探討一位因對高血壓認知不足，血壓控制 不理想，而引發再次腦中風個案，導致左側肢體無 力，造成日常生活上的改變，因而身心俱疲造成無 力感之護理經驗。於2018年9月15日至2018年9月26 日照護期間，藉由觀察、會談、直接照護及身體評 估方式收集資料，並運用Gordon十一項健康功能 型態評估為工具，經分析確立個案主要有「身體活 動功能障礙」、「知識缺失」及「無望感」三項護 理問題。護理過程中，藉由傾聽、陪伴、關懷，建 立良好護病關係，配合醫療處置並提供復健治療計 畫，鼓勵儘早執行主動、被動全關節運動，改善個 案身體活動功能；提供疾病治療相關訊息，衛教正 確用藥、定時測量血壓的重要，及採低鹽飲食，提 升疾病相關照護認知，增進疾病照護認知；協助個 案正視左側肢體無力的改變，引導個案表達心中的 感受，進而增強復健動機並參與治療來促進身體功 能的恢復，鼓勵家屬給予支持，增加對疾病的正向 看法，增進自我控制感與自信心，改善無望感，以 提升生活品質。建議臨床護理同仁在照護此類病人 時，除提供個別性復健訓練並適時做調整外，可多 了解病人心理因應調適狀況，引導正確積極正向態 度面對復健治療過程，重拾自信心。（澄清醫護管 理雜誌 2021；17（3）：67-76）。

The experience of nursing a patient with recurrent stroke was discussed in this article. The patient's condition case was caused by their lack of knowledge on hypertension and a poor blood pressure control. The recurrent stroke made the patient experience weakness on the left side of the body, which led to further consequences in their daily life, including physical and mental exhaustion. Data were collected through observation, interviews, direct care, and physical assessment during the nursing period from September 15 to 26, 2018. The results were evaluated using Gordon's Functional Health Patterns Assessment. Three concerns of the patient were raised during the nursing period: '' impaired physical mobility'', '' deficient knowledge'', and'' hopelessness''. Different nursing care methods, such as listening, companionship, and demonstrating care were provided and used to establish a good nurse-patient relationship. Rehabilitation plans were provided in accordance with medical treatment. In order to improve physical function, the patient was encouraged to adopt both active and passive total joint exercises in the early stage of the rehabilitation process. The patient's disease care awareness was promoted through providing treatment-related information, educating on the importance of following the importance of medication and treatment adherence , regular blood pressure measurement, and advising the adoption of a low-salt diet. We further assisted the patient to overcome the issue of weakness in the left limbs and encouraged the expression of the patient's feelings, thus improving both motivation for rehabilitation and treatment participation to promote physical recovery. We encouraged the family members to provide support to the patient which could increase the positive attitude of the patient towards the disease, enhance selfcontrol and self-confidence, reduce feelings of hopelessness, and improve quality of life. We recommend that when caring for such patients, in addition to providing individual rehabilitation training and making timely adjustments to this, nursing providers should also pay increased attention to the psychological adjustment of patients to their health condition, guide and support them in maintaining positive attitudes during the rehabilitation process, and help rebuild their self-confidence. (Cheng Ching Medical Journal 2021; 17(3): 67-76)