初發腦中風病人接受急性後期照護模式（PAC）之初期經驗研究

Initial Experience with the Post-acute Care Model (PAC) for Patients with First-onset Stroke

腦中風的發生是造成民眾失能的主要原因之一，而其失能後持續使用醫療資源是社會的龐大負擔；急性後期醫療整合照顧（PAC），依據中風病人失能嚴重程度與復能潛能，在復能黃金期內給予積極性、高強度及高頻率之復能照護，可以有效的減輕家庭及社會照顧之負荷、降低死亡率、並且顯著改善病情與提升健康相關生活品質。然而過去較少針對初發腦中風病人利用PAC之經驗研究，本研究以初發腦中風病人為研究對象，主要瞭解初發腦中風病人接受PAC計畫的初期經驗分析。研究方法以質性面對面的深入訪談進行資料收集，研究場域以立意取樣選取台北市某社區醫院之急性後期照護病房6位初發腦中風病人為訪談對象。研究收案期間為2022年2月至4月，研究倫理已通過「馬偕紀念醫院人體研究倫理審查委員會」審查（IRB編號：21MMHIS380e）。以半結構式訪談大綱進行資料收集，主要資料收集為病人住院接受急性後期整合照顧滿一週，評估其初期接受照顧的經驗與感受。研究結果顯示初發腦中風病人在接受PAC滿一週，主要的核心主題為「茫然失措」，意旨心中出現困惑，不知道如何是好。個案本身過去沒有實際的中風經驗，突發性的中風倒下後失去了原有的日常生活基本能力，而後衍生出許多問題及困惑，這部分又可再分為「悲傷」、「順從安排」及「膽怯」等三個次主題。研究對象因無預期性的突發中風而倒下，造成其身心無法接受失能的事實，在個案及家屬對個案的恢復都有所期望，希望可以回到以往的生活型態，只能選擇醫師的專業建議而順從安排參加PAC計畫。但在PAC治療過程中，初期時常出現自我懷疑，是否可以勝任某個任務或是執行某項動作，而又害怕自己做不到或是造成而次傷害，在這糾結當中，害怕自己無法做到的心理行為表現。研究建議此時期面對個案的心理障礙，應給予適當的疾病衛教及家屬支持陪伴，增加病識感與接受失能的事實，使其逐漸自我調適，學習如何去克服困境，並持續接受PAC整合性復能治療提升其生活品質。

The occurrence of stroke is one of the major causes of disability, and the continued use of medical resources after disability is a huge burden on society. Post-Acute Care (PAC), which provides active, high-intensity and high-frequency reablement care during the golden period of recovery, can effectively reduce the burden of family and social care, reduce mortality, and significantly improve the condition and health-related quality of life, depending on the severity of disability and reablement potential of stroke patients. However, there are few empirical studies on the use of PAC in patients with first-ever stroke. This study was conducted to understand the initial experience of PAC in patients with first-onset stroke. The study was conducted by qualitative face-to-face in-depth interviews, and the study site was selected from a community hospital in Taipei with a sample of 6 patients with first-onset stroke. The study period was from February to April 2022, and the ethics of the study was reviewed by the Ethical Review Board of Human Research of the MacKay Memorial Hospital (IRB No. 21MMHIS380e). A semi-structured interview protocol was used to collect data from patients who had been hospitalized for one week for post-acute integrated care, and to assess their experiences and perceptions of their initial care. The study revealed that the main core theme of the first stroke patients at the end of the first week of PAC was“confusion”, meaning that they were confused and did not know what to do. The case had no previous experience of stroke, and the sudden stroke resulted in the loss of the basic abilities of daily life, which led to many questions and confusion. The main theme can be further divided into three sub-themes:“sadness”,“obedience”and“timidity”. The subject collapsed due to an unanticipated sudden stroke, causing him to be physically and mentally unable to accept the fact that he was incapacitated. Both the case and the family had expectations of recovery and wanted to return to their old lifestyle, so they had to choose the doctor’s professional advice and comply with the PAC program. However, during the PAC treatment process, there is often self-doubt at the beginning, whether they can perform a certain task or action, but they are afraid that they will not be able to do it or cause secondary harm, and in this entanglement, they are afraid that they will not be able to do it. The study suggests that during this period of psychological disorders, appropriate health education and family support should be provided to increase the sense of illness and acceptance of the fact of disability, so that they can gradually self-adjust, learn how to overcome difficulties, and continue to receive PAC integrated rehabilitation treatment to improve their quality of life.