一位因跌倒導致腦部創傷老人之重症護理經驗：以病人及家庭為中心的照護模式

鄭淑允; 陳玉如; 蔣立琦

doi:10.3966/102673012017062802011

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P314 - 323

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6386/CGN

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一位因跌倒导致脑部创伤老人之重症护理经验：以病人及家庭为中心的照护模式

The Critical Nursing Care Experience of a Falling Elderly Patient with Traumatic Brain Injury based on the Patient and Family Centered Care

郑淑允(Shu-Yun Cheng) ；陈玉如(Yu-Ju Chen) ；蒋立琦(Li-Chi Chiang)

长庚护理； 28 卷 2 期 (2017 / 06 / 01) ， P314 - 323

繁体中文 DOI： 10.3966/102673012017062802011

病人及家庭为中心；脑部创伤老人；跌倒； patient and family centered care ； traumatic brain injury elderly ； falling

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摘要 │ 参考文献 (26) │ 国际计量

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Accidental falls are the major cause of traumatic brain injury among elderly community members. Elderly people who have a history of falls are likely to fall again and are vulnerable to brain injury. Traumatic brain injury may compromise the physical, emotional, behavioral, and cognitive functions of elderly patients and might engender considerable physical and mental effects on the patients and their family caregivers. Nurses are required to provide patients with an acute care phase as well as to offer mental support to the patients' family members and teach them care skills. In this study, the Patient and Family Centered Care (PFCC) in addition to holistic and individualized intensive nursing care were provided to a 75-year-old patient who had traumatic brain injury induced by an accidental fall because of an episode of dizziness just after a cataract surgery. The author provided primary and direct care to this patient from November 18 to November 26, 2014. During the intensive care period, the author accompanied the patient and family caregivers to experience the challenges posed by the patient's critical condition and acute consciousness changed and received emergency surgery for extra-ventricular brain drainage. To comprehend the patient's and family caregivers' physiological, psychological, spiritual, and social needs, the author evaluated them through observation, in-depth interviews, and physical assessment. Three major problems were found in this patient: ineffective cerebral tissue perfusion, the family caregivers' stress related to caring for the critically ill patient at home, and the high risk of recurrent falls. An evidence-based nursing protocol was used to care for this patient. Nursing interventions emphasized maintaining normal cerebral blood perfusion to reduce brain damage, providing detailed information related to the patient's medical condition, administering treatment to reduce the stress and anxiety of the patient's family members, and preventing recurrent falls to ensure home care safety. In addition, the nursing care information of post intensive care was provided to promote family coping and adaptation of patient's physiological and psychological impairment, and also to achieve successful transition of post- ICU discharge for family caregivers.

参考文献 ( 26 ) 〈TOP〉

(2008).Patient safety and quality: An evidence-based handbook for nurses.U.S:AHRQ..
American Association of Neuroscience Nurses,Association of Rehabilitation Nurses(2011).American Association of Neuroscience Nurses, Association of Rehabilitation Nurses. (2011). Care of the patient with mild traumatic brain injury. AANN and ARN Clinical Practice Guideline Series..
Arango-Lasprilla, J. C.,Quijano, M. C.,Aponte, M.,Cuervo, M. T.,Nicholls, E.,Rogers, H. L.,Kreutzer, J.(2010).Family needs in caregivers of individuals with traumatic brain injury from Colombia, South America.Brain Injury,24(7-8),1017-1026.
Bischoff-Ferrari, H. A.,Orav, E. J.,Dawson-Hughes, B.(2008).Additive benefit of higher testosterone levels and vitamin D plus calcium supplementation in regard to fall risk reduction among older men and women.Osteoporosis International,19(9),1307-1314.
Boltz, M.,Capezuti, E.,Fulmer, T.,Zwicker, D.(2012).Fall prevention. In: Evidence-based geriatric nursing protocols for best practice.National Guideline Clearinghouse.

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