题名

運用Watson理論於腦中風導致吞嚥障礙個案之照護經驗

并列篇名

Caring Experience from Applying Watson's Caring Theory for Dysphagia in Stroke Patients

DOI

10.29494/LN.202203_23(1).0004

作者

鄭雪梅(Hsueh-Mei Cheng);劉錦茹(Chin-Ju Liu)

关键词

吞嚥障礙 ; 無望感 ; 腦中風 ; dysphagia ; hopelessness ; stroke

期刊名称

領導護理

卷期/出版年月

23卷1期(2022 / 03 / 01)

页次

30 - 48

内容语文

繁體中文

中文摘要

本篇描述一位初診斷腦中風合併吞嚥障礙個案,面對疾病及失能衝擊,伴隨主要照顧者身心負荷之護理經驗。筆者於2018年07月11日至7月26日護理期間,藉由觀察、病歷查閱、身體評估、訪談個案及照護者運用生理、心理、社會及靈性層面進行整體性護理評估,確立健康問題:吞嚥障礙、身體活動功能障礙、無望感及照護者角色緊張等健康問題,運用Watson關懷理論於臨床照護中。吞嚥障礙方面,結合跨團隊醫療合作進行直接吞嚥訓練及口腔主動性運動,教導正確進食步驟,改善吞嚥障礙及預防吸入性肺炎發生;身體活動功能障礙方面,病友經驗交流,復建科團隊與個案共同訂定計劃,轉介出院服務組提供租借輔具資訊及社會資源協助,幫助個案恢復最佳肢體功能;無望感方面,藉由貝克無望感量表評估,及時導入親情陪伴關懷因子、正念支持及音樂療法降低無望感;照顧者角色緊張方面,給予心理支持及正向回饋、教導智慧型手機輔助教學、家庭成員照顧人力資源重整及引導個案感謝照顧者等,以減輕照顧者角色緊張。建議照護此類個案,除提供照護知識及技能外,也應依據其個別性,協同各領域專家以提供整合性照護。

英文摘要

This article described the nursing experience when caring a newly diagnosed stroke patient combined with dysphagia whom also faces the impacts of disease and disability; and accompanied to both physically and psychologically distressed primary caregiver. During the nursing period of July 11 to 26 in 2018, the authors applied Full Functional Health Patterns as the assessment tool to observe and review medical report; physical assessment and interview the case with the caregiver to identify health issues such as dysphagia, physical disability, hopelessness and the caregiver anxiety. By applying Watson's Caring Theory in clinical practice, nursing staffs integrated interdisciplinary team work into the following aspects: 1) In the aspect of Dysphagia, direct swallowing training and active oral activities, accurate eating procedure instructions to improve dysphagia and aspiration pneumonia prevention; 2) In terms of Physical Dysfunction, patients experiences sharing among themselves, training program established jointly between cases and the rehabilitation professionals, the supplement of assistive device and social resource information through the discharge planning to help the patient restore optimal physical function; 3) In terms of hopelessness, the application of Beck Hopelessness Scale (BHS) was introduced to timely import family companionship, Mindfulness-Based Stress Reduction (MBSR) and musical therapy to reduce patient's hopelessness; 4) In the aspect of caregiver, the provision of psychological support and positive feedback, the guidance of smart phone application utilization, reorganization of family resource for caregiving and the induction of showing appreciation to relieve the tension of the caregiver. It is recommended that when caring for similar cases, in addition to provide care knowledge and skills, also to base on case characteristics, and collaborate with experts in various fields to provide integrated care.

主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
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被引用次数
  1. 謝春滿,黃惠滿,黃莉雯,張薰文(2023)。一位初次腦中風合併發音不良及吞嚥困難患者之門診照護經驗。台灣健康照顧研究學刊,27,42-59。
  2. (2024)。照護一位腦中風復健個案之照護經驗。彰化護理,31(1),122-133。