運用自立支援模式照顧老年失明者遷住機構之經驗

Using Reablement Methods to Facilitate a Visually Impaired Older Adult Getting through Relocation

本篇敘述協助一位85歲個案，因老年雙眼失明及半年內遷居兩所長照機構，對環境產生極大的不安全感與焦慮，引發遷移壓力症候群之照護經驗。筆者自2016年6月3日至9月3日護理期間，以五大層面作整體性評估，運用觀察、會談、直接照護、病歷查閱等技巧收集資料。確認個案主要健康問題為：遷移壓力症候群、自我照顧能力缺失、社交隔離。筆者於照護期間因個案無法適應新環境而出現妄想及焦慮，首先建立良好的護病關係，以提升對工作人員的信任感，再透過會談、傾聽，給予適當的心理支持及提供現實感，陪同探索周遭環境。又因雙眼失明無法自行如廁，故提供個別化日常生活訓練，同時融入自立支援照護模式，增進自我照顧能力，終達不尿布、不約束、不臥床之「三不原則」。個案多次拒絕參與活動，且不願與其他住民互動，了解原因後，鼓勵參與活動，如：戶外旅遊及歌唱比賽，過程中不斷給予正向支持、肯定，提升個案自信心及促進人際互動，進而改善生活品質，使其能成功適應遷居養護中心之嶄新生活。

This written work focuses on an 85 year old visually impaired individual who was forced to relocate twice within 6 months due to becoming visually impaired. It also provides details on care provided for the elderly individual who suffered from relocation stress syndrome, induced by the sense of insecurity and anxiety in relocating. From June 3rd–Sept 3rd 2016 nursing period, overall assessment is conducted through five perspectives. By referring to data collected through observation, conversation, direct care and medical reports, it has been confirmed that the elderly individual suffers from relocation stress syndrome, inability to self-care and social isolation. The writer witnessed the individual suffer from paranoia and anxiety due to being unable to adapt to the new environment, which is why a strong bond was established, so as to enhance the individual’s trust of the working staff. The staff engaged in conversation with the individual, listened to the individual’s needs, provided moral support and a sense of reality, in addition to companionship in exploring the living environment. As the individual was visually impaired and incapable of going to the toilet, staff members tailored a customized training which focuses on reablement and the ability to self-care, thereby achieving the“Three No”principle–No diapers, no restrictions, no bedridden life. The individual refused on multiple occasions to participate in activities and was reluctant to interact with other residents. After identifying the reasons, the individual was encouraged to participate in activities such as outdoor travel and singing competitions. Positive encouragement and support was given in allowing the individual to regain self-confidence and stimulate social interaction, ultimately improving living quality.