一位右側梗塞性腦中風導致肢體偏癱之出院準備服務經驗

Experience of Applying Discharge Planning Service for A Patient with Limb Hemiplegia Caused by Right Infarct Stroke

本文探討一位67歲男性，因右側中大腦梗塞導致左側偏癱的護理經驗，照護期間2019年2月20日至4月18日，運用Gordon十一項功能性健康型態做為評估工具，確認個案有身體活動功能障礙、吞嚥功能障礙、家庭因應能力增進的準備度護理問題。照護期間，主動召開家庭會議，應用醫病共享決策概念，討論急性後期照護和復健計畫，透過翻轉教學策略，進行平衡肌力訓練、吞嚥訓練，改善左側偏癱並成功拔除鼻胃管由口進食；連結長期照顧服務資源，減輕案妻照顧負擔，順利讓家庭回歸正常生活運作。建議面對腦中風後有家庭照顧的問題，連結出院準備團隊的運作，依案家需求積極提供長照資源整合輔助，使個案能獲得持續性照護，家屬也有喘息時間。

This study reported the experience of caring for a patient with limb hemiplegia caused by right infarct stroke. From February 20 to April 18, 2019, the methods of communication and meetings following the“Gordon 11 Function Health Pattern”were applied to analyze the case’s data and summarize the main nursing problems of this case, including physical dysfunction, dysphagia, and family’s ability to respond. During the nursing process, we established a good nurse-patient relationship by actively organizing family meetings, applying the concept of“Shared Decision Making”(SDM), and discussing acute post-care and rehabilitation plans. Then, flipped teaching strategies were applied for muscle balance and swallowing training. The left side hemiplegia was improved, and the nasogastric tube feeding was successfully removed. This strategy connected long-term care service resources, reduced the burden for the wife of the patient, and helped the patient to smoothly return to normal life functions. Therefore, when we face stroke patients having family care problems, it is recommended that we connect with the discharge planning team, and actively provide long-term care resource integration assistance according to the needs of the patents’families. By doing so, the patient can receive continuous care, and the family members also gain breathing space.