初次腦中風導致家庭運作過程改變個案之門診護理經驗

The Outpatient care Experience of a Patient with Primary Brain Stroke Leading to Changes in Family Operations

本文是探討一位64歲女性初次罹患腦中風，導致家庭運作過程改變之門診護理經驗。筆者於2015年8月3日至2015年10月30日三個月照護期間，經9次門診訪視及4次電話訪談，運用觀察、會談、電訪及傾聽方式，採Gordon十一項功能性健康型態進行整體性評估，歸納及分析出個案健康問題，包括身體功能障礙、焦慮及家庭運作過程改變。筆者於護理過程中，藉由轉介物理治療師及採漸進式活動指導，建立個案對疾病治療與復健重要性的認知，增強復健活動的意願；而當面對因疾病而導致活動障礙造成負面情緒反應，則主動藉由關懷、同理心，鼓勵表達內心感受，並經由醫療團隊共同處理其家庭與社會方面的衝擊，如提供社會福利資源與出院準備服務，連結相關醫療資源，給予適切的後續照護，藉此讓家庭回歸正常運作。期望此經驗能增加護理人員對於腦中風患者認識，提供具體有效護理措施解決個案之護理問題，使其病人及家庭能順利渡過疾病與復健治療過程。

This study examined the outpatient care experience of a 64-year-old woman who had a cerebral stroke, resulting in family operations in her family. During the three months of care provided from August 3 to October 30, 2015, the author employed observations, interviews, and listening methods in accordance with Gordon 11 Function Health Patterns or holistic assessment, and conducted nine outpatient visits and four telephone interviews. The data gathered were analyzed to identify the patients' health problems, including physical dysfunction, anxiety, and changes in the family's living arrangements. During the nursing process, the author established the patient's awareness of the importance of disease treatment and rehabilitation by referring to physiotherapists and adopting progressive activity guidance, for strengthening the patient's willingness to undergo rehabilitation activities. Regarding negative emotions caused by disease-related activity disorders, the patient was encouraged to express her feelings by the author's active demonstration of care, empathy, and encouragement. In addition, a medical team was responsible for handling family and social impact, such as providing social welfare resources and discharge preparation services, linking relevant medical resources, and providing appropriate followup care so that the patient's family can resume normal functioning. It is hoped that this experience will increase the awareness of nursing staff caring for patients with cerebral stroke and provide specific effective nursing measures to solve the nursing problems of patients, thereby helping patients and families to successfully overcome the disease through a rehabilitation treatment process.