照顧一位初次腦中風個案之護理經驗

Nursing Experience of Caring for a First-Time Stroke Patient

本文敘述一位56歲男性初次腦中風個案之護理經驗。護理期間為2024年3月3日至3月22日，採用Gordon十一項健康功能型態評估，藉由觀察、會談、直接照護和身體評估等方式收集資料，確立有身體活動功能障礙、吞嚥障礙及焦慮之護理問題。個案因腦中風導致左側肢體偏癱和吞嚥困難，面對疾病衝擊產生焦慮不安，對康復的未來充滿不確定性，且預期自身狀況不會改善，促使筆者探討之動機。照護過程中，通過主動關懷、傾聽、陪伴與個案建立良好護病關係，鼓勵個案表達心中感受，藉由分享復健成功案例以減少焦慮和負面情緒。配合臨床醫療處置以及與跨領域團隊、個案及家屬共同參與，制定個別性復健計畫，運用專業知識及技能，激發個案復健動機，並透過吞嚥訓練、口腔運動和下巴阻力運動（CTAR）等方法逐步恢復其吞嚥功能。建議護理人員在提供照護知識與技能的同時，可根據個別需求調整護理與復健計劃，最終使其能得到良好身心調適，回歸日常生活，提升生活品質。期望此護理經驗能為日後臨床照護提供參考。

This article describes the nursing experience of a 56-year-old male patient who experienced a first-time stroke. The care period lasted from March 3, 2024, to March 22, 2024, during which Gordon's Eleven Functional Health Patterns were used to assess the patient. Data were collected through observation, interviews, direct care, and physical assessments, identifying nursing issues such as impaired physical mobility, swallowing difficulties, and anxiety. The patient experienced left-sided hemiplegia and swallowing difficulties due to the stroke. The shock of the illness led to anxiety and uncertainty about his future recovery, and he expected that his condition would not improve, which motivated the author to explore. Throughout the care process, a strong nurse-patient relationship was established through proactive care, listening, and companionship, encouraging the patient to express feelings and share successful rehabilitation cases to reduce anxiety and negative emotions. In collaboration with the clinical team, patient, and family, an individualized rehabilitation plan was developed. Professional skills were used to boost the patient’s motivation, with methods like swallowing training, oral exercises, and Chin Tuck Against Resistance (CTAR) exercises gradually restoring swallowing function. It is recommended that nursing staff adjust care and rehabilitation plans according to individual needs while applying care knowledge and skills. This approach aims to help patients achieve proper physical and mental adjustment, return to daily life, and improve their quality of life. It is hoped that this nursing experience will serve as a reference for future clinical care.