協助一位年輕型中風個案早期復健之加護經驗

An Intensive Nursing Experience of providing early rehabilitation for a young patient with stroke

本文探討一位39歲男性初次罹患腦中風之加護護理經驗，照護期間為2019年11月13日至11月21日，個案因左側肢體障礙，從家中支柱角色轉變成需依賴他人，不願面對家人、擔心難以重返職場，進而出現負向情緒。運用Gordon十一項健康功能型態全面評估個案，藉由身體評估、觀察、會談等方式收集資料，確立個案有顱內調適能力降低、身體活動功能障礙及無力感等健康問題。藉由預防顱內壓升高及疼痛管理之相關照護措施，減少個案不適感受，並防止神經學進一步惡化;運用跨領域團隊資源，擬定並提供個別性復健計畫;然而，個案因初期復健成效不顯著而產生自我懷疑、對未來感到無力不安，幸在筆者及家屬共同努力下，持續鼓勵其參與自我照顧，重新建立控制權，肯定自我價值，終於讓個案願意面對疾病帶來的身體功能殘缺，主動參與復健，並對未來生活有了目標及期待。建議單位定期舉辦長期照護系統課程或提供長照課程資訊，培養加護病房護理師對於長期照護之認知，適時提供並善用資源，減少個案心中對未來的不安，降低長期失能風險，以期能早日恢復日常生活並重返職場。

This article describes the experience of caring a 39 years old male with first stroke in the intensive care unit (ICU) from November 13 to November 21, 2019. Because of left side hemiparesis, the patient needed to depend on others, so he didn’t want to face his family anymore and worried about returning to work. With the huge change in the breadwinner role; therefore, the patient had negative emotions. Through physical assessment, observation and interview, we collected data comprehensively by Gordon´s 11 Functional Health Patterns and identified the following health problems reduced intracranial adaptive capacity, physical activity dysfunction, and powerlessness. To reduce discomfort and prevent further neurological deterioration, we provided the nursing interventions, such as prevention of increased intracranial pressure and pain management, etc. Collaborate with other medical professionals to plan an individual rehabilitation schedule. However, the initial effect of rehabilitation was insignificant, patient felt self-doubt and frustrated about future. After we kept encouraging and enabling patient with family to join the self-care plan, he rebuilt his control ability and self-worth; finally, accepted changes in his physical impairment, participated in rehabilitation of his own accord ,and had goals and expectations for the future. Registered nurses in the ICU should get some knowledge about long-term care. It is recommended the unit could periodically hold classes or provide relative course information. When necessary, the nurses could make good use of relieving patients’worry and reducing the risk of long-term disability. Then we could look forward to their returning to normal life soon.