應用實證足部護理介入措施照顧一位非糖尿病足高齡臥床長者：個案研究

Application of Evidence-Based Foot Care Interventions in Caring for an Elderly Bedridden Individual with Non-Diabetic Foot: A Case Study

本文旨在探討一位在宅93歲非糖尿病足高齡臥床長者之足部護理經驗。照護期間為2022年6月13日至8月16日，運用老人周全性評估，透過病史收集、病歷查閱、會談、觀察等方式蒐集資料，確立主要護理問題有（1）知識缺失、（2）皮膚完整性受損、（3）現存性皮膚感染。照護過程中透過實證文獻搜尋足部護理照顧措施於個案的足部照護，應用紙本、Line APP、多媒體教材與翻譯軟體指導高齡與外籍照顧者足部護理方法，提升照顧者足部照護知識與技能，使個案足部皮膚龜裂、紅疹、厚繭、浸潤與厚甲獲得改善。運用遠端跨專業團隊合作方式，解決案家位處東部偏鄉，就醫不便，及高齡照顧者擔心新冠肺炎疫情期間，個案外出就醫恐會染疫之困難點。透過此個案實證照護經驗，未來建議社區醫療照護人員要持續接受足部照護教育課程，以提高足部照護能力，且對於外籍或高齡之家庭照顧者，要注意其對足部健康照顧知識，以達到社區長者的足部健康。

This article aims to explore the foot care experiences of a 93-year-old bedridden elder with no history of diabetes. The care period was from June 13 to August 16, 2022. Using a comprehensive geriatric assessment, data were collected through medical history review, interviews, and observations. The main nursing issues identified were: (1) knowledge deficit, (2) impaired skin integrity, and (3) existing skin infection. Throughout the care process, evidence-based literature was reviewed, and foot care guidelines were applied to the case. Educational resources, including printed materials, the Line app, multimedia tools, and translation software, were utilized to enhance senior and foreigner caregivers’knowledge and skills in foot care. This led to improvements in the patient’s foot condition, including reduced skin cracking, rashes, calluses, and onychomycosis. A remote, interdisciplinary team approach was employed to address challenges such as the patient’s location in a rural area, difficulties in accessing medical care, and concerns from the senior caregiver about potential COVID-19 exposure during hospital visits. Based on this case study, it is recommended that community healthcare providers continue to receive education on foot care to improve their competencies. Additionally, special attention should be given to foreign or elderly family caregivers regarding their knowledge of foot health to promote the foot health of seniors in the community.