一位毛毛樣腦血管疾病個案之照護經驗

Nursing Experience of Caring a Patient with Moyamoya Disease

本文是描述罹患一位女性罹患毛毛樣腦血管疾病導致個案右側肢體無力，筆者於2018年1月18 日至2018 年2 月16 日的照護期間，藉由觀察、會談方式收集資料，並運用傾聽、正向支持、同理等技巧，建立關係並確立健康問題，以Gordon 十一項健康功能型態分析及評估，發現個案的主要護理問題為：身體活動功能障礙、個人因應能力失調、照顧者角色緊張，於護理過程中，筆者先與病人和照顧者建立信賴的治療性人際關係，透過病人與復健團隊共同制定復健計畫，激發個案的復健動機，能配合參與復健活動，並能在病室自主練習，增進其身體活動功能及自我照顧能力的進步，並運用傾聽與引導技巧，讓個案說出心裡的擔憂，透過病友會轉介背景相似復健成功案例，減輕對疾病的不安與困惑，提升自信心；照顧者方面，藉由會談及主動關懷，指導疾病照護相關技能，降低照顧者照護技能不足及角色轉換的擔憂，配合照顧者信仰安排宗教師提供心靈上的撫慰。期望透過此個案護理經驗的分享，作為日後照護此類個案之參考，使護理人員獨特角色功能得以發揮。

This article describes the nursing experience of caring a female patient who suffered from the right side limb weakness due to Moyamoya Disease. During the nursing care period from January 18th to February 16th, 2018, the author used observation and interviews to collect patient’s information and applied techniques so as listening, positive support, and empathy to build relationships and identify her health issues. Gordon’s Functional Health Patterns were used for overall assessment, The identified health problems included physical activity dysfunction, personal dysfunction, and caregiver role strain. In the process of nursing, a reliable therapeutic interpersonal relationship with the patient and her caregiver was established. Through the rehabilitation plan jointly developed by the patient and the rehabilitation team, a, the treatment team encouraged the patient to comply with the rehabilitation activities and to do exercise trainings independently to improve her physical activity and self-care ability. Psychologically, by using listening and guiding skills, we led the patient to share her concern and anxiety, then reduced her fear and confusion about the disease, and enhanced her self-confidence through sharing experiences and stories from a successfully recovered patient. In addition, through conversation and active care, we improved the caregivers' caring skills, reducing the patient’s concerns about inadequate caregivers’caring skills and role transitions. We also arranged the religious instructors to provide spiritual comfort to the patient. This experience can be shared as a reference for providing cares to similar patients.