運用賦能照顧一位後天免疫缺乏症候群併隱球菌腦膜炎腦損傷患者之護理經驗

本文個案為一位35歲後天免疫缺乏症候群併隱球菌腦膜炎腦損傷之男性患者，因病況導致腦損傷、認知功能受損，使其日常生活無法自理，需長期臥床，家人初次面臨照護臥床病患，對於許多照護技巧不熟稔，顯緊張、焦慮，且個案及案母對於往後疾病走向及照護方式不甚理解，雙方也缺乏相互溝通，故期望能透過賦能的運用，增進病人認知能力、日常生活品質，同時增強案母照護品質及促進雙方溝通。照顧期間自108年12月3日至12月17日，以生理、心理、靈性、社會等四個層面進行評估，診斷個案有「慢性混亂/腦膜炎導致部分認知功能缺損」、「身體活動功能障礙/與肌肉力量不足有關」、「照顧者角色緊張/初次照護臥床病人」之健康問題，護理過程中透過「與病患發展良好的治療性關係」、「根據所需加強觀念及能量」、「共享決策」、「拓展個人能力」、「促進學習體驗」、「告知照顧者可能存在之危險」、「加強照顧者之自我效能及增加自信」等賦能方式解決個案健康問題，凸顯護理於相關情境中之價值。

This case involves a 35-year-old male with acquired immune deficiency syndrome and cryptococcal meningitis, resulting in brain injury and impaired cognitive function. Consequently, he is unable to care for himself and is bedridden. His family, unfamiliar with many care techniques and uncertain about the disease's progression, feels nervous and anxious. Additionally, there is a lack of communication between the patient and his mother. Therefore, the goal is to use empowerment to enhance the patient's cognitive function and quality of life, while also promoting better communication between them. The care period was from December 3 to December 17, 2019. Nursing interventions were conducted at four levels: physical, psychological, spiritual, and social. The diagnoses included ''chronic confusion due to meningitis leading to partial cognitive impairment,'' ''physical dysfunction related to insufficient muscle strength,'' and ''caregiver role strain due to the first-time care of a bedridden patient.'' Empowerment methods used included: developing a strong therapeutic relationship with the patient; strengthening concepts and energy according to needs; sharing decision-making processes; expanding personal abilities; promoting learning experiences; informing caregivers of potential care risks; and enhancing the self-efficacy and self-confidence of caregivers. These strategies addressed the patient's health problems and highlighted the value of nursing in improving care outcomes.