運用自我調節理論提升老年心衰竭患者自我照護經驗

Experience of Improving Self-care Using the Self-regulation Theory in an Elderly Patient with Heart Failure

本文照護一位獨居老人心衰竭反覆入院之護理經驗，並以自我調節理論模式為護理過程之基礎，透過直接照護、身體評估、觀察、會談及查閱病歷等方式，依生理、心理、靈性與社會等層面作整體性護理評估收集資料，照護時間於2020年1月18日至1月23日，經過健康評估分析確立個案有「心輸出量減少」及「無效性健康維護能力」之健康問題，個案因心衰竭症狀加劇反覆入院，會談後發現個案對於疾病相關知識不足，自我照顧能力缺乏，筆者在護理過程多予傾聽與陪伴，且鼓勵家屬予個案心理支持，並提供疾病相關知識，且給予個別性護理措施，教導居家自我照護技巧。以提升自我照護品質為目標，運用自我調節理論「PRIDE」教育計畫引導個案自我探索找出問題，再透過行為修正來達到症狀緩解、疾病知識度增加，運用自我檢核表以落實自我照護管理能力。建議此類個案出院可協助轉介社福單位加強後續追蹤，可結合長照2.0計劃或建議家屬機構式照護，並予定時訪查監控個案出院後的生理機能狀況，減少獨居產生的社交隔離感，避免疾病控制不佳再度入院，希望分享此照顧經驗提供臨床護理人員參考。

This article describes the nursing experience of an elderly patient living alone with poorly controlled heart failure and repeated hospital admissions. The self-regulation theory was used as the basis of the nursing care, and the data for the comprehensive nursing assessment based on physical, psychological, spiritual, and social aspects were collected through direct patient care, physical assessment, observation, interviews, medical records, etc. The nursing care lasted from January 18 to 23, 2020. The patient was determined to have“decreased cardiac output”and“ineffective health maintenance ability”after health assessment and analysis. Moreover, the patient was repeatedly admitted to the hospital due to worsening symptoms of heart failure. It was found in the interview that the patient had insufficient knowledge about the disease and lacked self-care capacity. The author made extra effort to listen to and accompany the patient during the nursing care process, and encouraged the family members to provide psychological support to the patient. Moreover, the author also provided knowledge about the disease and individualized care measures, and taught the patient self-care skills that could be used at home. Using the“PRIDE”education program of the self-regulation theory was applied to guide the patient to identify problems through self-exploration with the goal of improving the quality of self-care. The patient obtained symptom relief, an increase in their knowledge of the disease, and the ability to use aself-checklist to implement self-care management through behavior modification. Such cases should be referred to social welfare institutions to enhance post-discharge follow-ups. The long-term care 2.0 program may be combined and institutional care with family caregiving may be suggested. Moreover, the physical function of the patients after discharge should be monitored with regular visits to reduce the social isolation caused by living alone and to avoid re-hospitalization due to poor disease control. The author hopes to share this care experience to provide references for clinical nursing staff.