運用自我效能理論照顧一位再次腦中風個案之護理經驗

Nursing Experience of Applying Self-Efficacy Theory to a Patient with Recurrent Stroke

再次腦中風會增加病人失能的嚴重度甚至死亡的風險，不但嚴重影響其生活品質且加重照顧者的負擔。本文為運用自我效能理論照顧再次腦中風個案之護理經驗。照護期間為2021年11月9日至12月1日，藉由身體評估、觀察及會談進行整體性評估，確立健康問題為身體活動功能障礙、呼吸道清除功能失效與焦慮。根據自我效能理論中的提供精通經驗、替代經驗、以言語讚美達到社會說服，和穩定生理與心理狀態擬定照護策略，並以實證文獻與照護指引擬定具體護理措施。透過與復健師討論提供個案合適的復健內容，輔以網路多媒體與病友經驗作為參考、鼓勵家屬陪伴個案復健使用影像記錄做為參考，以增進身體活動功能；藉由增加個案下床活動之動機減少臥床時間、協助執行胸腔物理治療與保持口腔清潔，以改善呼吸道清除功能失效；藉由強化個案過往成功經驗，協同家屬共同討論事件的感受及因應的方式，使用個案喜愛的休閒娛樂轉移住院負向的感受，以解決焦慮情況。期望藉此經驗提升再次腦中風病人的自我效能及解決健康問題，與臨床照護時運用理論基礎、實證文獻與跨團隊資源的重視。

Recurrent stroke increases patients’risk of disability and mortality. It not only affects patients’quality of life but also imposes a significant burden on caregivers. This report describes the nursing experience of applying self-efficacy theory to the care of a patient with recurrent stroke. The nursing period spanned from November 9 to December 1, 2021. A comprehensive assessment was conducted, and data were collected through physical assessments, observations, and interviews. The major health problems identified were impaired physical mobility, ineffective airway clearance, and anxiety. A care plan was developed based on self-efficacy theory using the framework of mastery experience, vicarious experience, social persuasion, and somatic and emotional states. Evidence-based clinical practice guidelines were incorporated into the design of nursing interventions. In collaboration with a physical therapist, we developed an appropriate rehabilitation plan. Internet-based multimedia resources and patient experience videos were used as references. Family members were encouraged to accompany the patient and use video recordings to enhance motivation and support physical activity. To improve the patient’s airway clearance, we promoted out-of-bed mobility by increasing motivation for physical activity, performing chest physiotherapy, and maintaining oral hygiene. To address anxiety, we strengthened the patient’s mastery experiences, encouraged family participation in sharing emotions and discussing coping strategies, and introduced recreational activities that the patient enjoyed to redirect attention away from negative feelings. This experience highlights the importance of applying self-efficacy theory in the care of patients with recurrent stroke by integrating theoretical frameworks, evidence-based practice, and interprofessional collaboration.