照顧一位腦中風個案之護理經驗

A Nursing Experience of Caring a Patient with Ischemic Stroke

本文描述一位48 歲女性腦中風個案，因中風導致右側肢體偏癱及合併失語症，個案無法接受疾病帶來的改變，出現情緒低落、無預警落淚情形，護理期間自2018 年3 月16 日至2018 年4 月12 日，運用Gordon 十一項健康功能型態評估，確立健康問題為：『身體活動功能障礙、言辭溝通障礙、無望感』。透過復健治療師共同擬定個別性的復健計畫與護理指導，增強肌力與身體平衡，預防關節孿縮，適時給予讚美，提升個案復健動機，增加我照顧能力，改善身體活動功能障礙。在言辭溝通上照護初期運用平板電腦文字擅打，建立良好溝通模式，並教導家屬調整和個案溝通方式，加上透過語言治療計畫，練習口語發聲並配合練唱方式，增加口語表達能力；在對未來無望的改善，照護初期藉由與個案及家屬建立信任關係，以主動關懷、陪伴、傾聽個案內心想法，帶領個案參與病友會，透過相似病友現身說法，讓個案知道自己是可進步，讓個案能重拾信心，再運用家庭支持系統提升其學習力，積極的參與復健面對未來，期望藉此護理經驗能提供護理人員臨床照護之參考。

This article described the nursing experience of caring a 48-year-old woman with ischemic stroke. Because of ischemic stroke, she had right side paraplegia and aphasia. She was not able to accept the sequela of ischemic stroke. Depressive mood with occasional tears developed. The nursing period was from March 16th to April 12th, 2018. Gordon’s Functional Health Patterns were used for overall assessment. The identified health problems included impaired physical mobility, dysarthria, and hopelessness. We set up a personalized rehabilitation plan and nursing guidance with a rehabilitation therapist. Through the plan, her muscle strength, body balance, and joint contracture were improved. We praised accordingly to increase her motivation for rehabilitation. Her self-care ability and activities of daily living were also improved. A tablet was provided at the early phase to assist self-expression. Family members were educated to modify communication methods to facilitate effective communication. In addition, her speech ability was enhanced by training programs, such as singing instruction. To improve her hopelessness, she was accompanied and listened to. Various patient groups were introduced to her, so that experiences from similar patients could be shared. Gradually, she regained her confidence after realizing that her conditions could improve over time. Furthermore, her learning ability was improved through supports from family. She participated in the rehabilitation program actively and was willing to face the future positively. This article can be shared as a reference for caring stroke patients.