輔導初次照顧氣喘兒童案家的照護經驗

First-time Nursing Consultation for Taking Care of A Child with Asthma: A Family Experience

本文描述一位初次診斷過敏性氣喘的六歲學齡前期兒童,案母否認孩子罹病的事實,未遵從醫囑回診及服藥的護理過程。護理期間自 2016 年 5 月 4 日至 7 月 6 日,運用 Gordon 十一項健康功能評估,確立健康問題有:照顧者否認行為不當、照顧者無效性健康管理及個案自我照顧能力不足。筆者以個案管理介入先取得案父 母信任後,澄清其對疾病的迷失,介紹病友家屬分享照護經驗,強化其支持系統,使父母接受個案罹病事實,並付諸行動維護及控制居家環境。引導照顧者與個案建 立合作關係,賦權兒童自我照顧能力,依其認知發展逐漸轉移照護責任給兒童,運用書及圖片進行指導性遊戲增加個案認知及配合度,及設定達成目標的集點卡,達 成目標時獎勵個案,增強其自我管理而穩定疾病。建議在住院期間可照會門診氣喘個案管理師,促使提早與個案及家屬建立關係,此將增加疾病照護衛教成效。

 

This case study describes the nursing experience of a preschool child of six years old firstly diagnosed with asthma. The mother denied the fact that the child was ill, and did not comply with the doctor’s advice and perscription of medication. The period of nursing care was from 4 May to 6 July 2016. Gordon 11 Function Health Patterns were used to establish health issues: caregiver denial of misconduct, invalid health management by the caregiver and inadequate self- care capacity of the case. The author first obtained the trust of the parents of the case with case management intervention, clarified their myths about the disease, introduced the family members of other patients to share the experience of care, strengthened the support system. These steps were taken so that the parents would accept the fact that the child was ill, and thus take action to maintain and control the home environment. We guided the caregiver to establish cooperative relationships with the child. We empowered the child to take care of himself, and gradually shifted the care responsibilities to the child according to his cognitive development. We also used books and pictures for instructional play to increase the case’s awareness and cooperation, and we used a rewards card to give rewards to the child when achieving the goals, in order to enhance their self-management and stabilize the disease. It is recommended that the outpatient asthma case manager be consulted during hospitalization to promote early development of relationships with the case and family members, which will increase the effective- ness of disease nursing education.