Nurses＇Experience of Caring for Delirious Patients

譫妄病患之護理經驗

羅美芳(Meei-Fang Lou)；戴玉慈(Yu-Tzu Dai)

照護經驗 ； 譫妄 ； 護理 ； caring experience ； delirious patient ； nursing

The Journal of Nursing Research

10卷4期（2002 / 12 / 01）

279 - 290

英文

譫妄為一老年住院病患常見的問題，本研究之目的在瞭解對譫妄病患之護理過程之經驗，以開放性面談方式，共收集四位元曾照顧過譫妄病患的護理人員之護理過程並將所得資料加以分析，結果發現整個護理經驗是—“尋求平衡”的過程，護理人員在平日沈重工作負擔及病患發性譫妄之不確定性二者間，試圖採取最佳措施來平衡此二種壓力，其所採取措施包括依賴家屬或其他病患的協助、確保病患安全、報告醫師處理、及同儕間相互支持。瞭解護理人員的經驗能讓護理管理者在在職教育及人力分配等各方面訂定措施，經由提升護理人員對譫妄之認知、評估、及處理技能，一方面能達到早期偵測譫妄之目的，另一方面能減輕基層護理人員壓力，以提升病患之護理品質。

This qualitative research was aimed at under standing nurses＇experiences of caring for delrious patients. Four in-depth open-ended interviews were analyzed. A model to present the caring experience was developed from the inter views. The experience of caring for the delirious patient is a process of “striving for balance”. Infor mants reported trying to deal with unan ticipated patient conditions and the unyielding work loads by balancing these two conditions. Some of the actions pursued included: relying on external resources, assur ing safety, reporting, and sup porting each other. Understanding nurses＇caring expeience is important for nurse admin is trators in helping the nurse man age delirious patients. Suggestions for future research are also made.

1. American Psychiatric Association(1994).Diagnostic and Statistical Manual of Mental Disorders: DSM-IV.Washington, D. C.:American Psychiatric Association.
2. Denzin, N.(1989).The research act: A theoretical introduction to sociological methods.Englewood Cliffs, NJ:Prentice-Hall.
3. Dolan, M. M., Hawkes, W. G., Zimmerman, S. I., Morrison, R. S., Gruber-Baldini, A. L., Hebel, R., Magaziner, J.(2000).Delirium on hospital admission in aged hip fracture patients: Prediction on mortality and 2-year functional outcomes.Journal of Gerontology: Medical Sciences, A,55
4. Dyer, C. B., Ashton, C. M., Teasdale, T. A.(1995).Postoperative delirium: A review of 80 primary data-collection studies.Archives of Internal Medicine,155
5. Eden, B. M., Foreman, M. D.(1996).Problems associated with under-recognition of delirium in critical care: A case study.Heart ＆ Lung,25(5)
6. Foreman, M. D.(1989).Confusion in the hospitalized elderly: Incidence, onset, and associated factors.Research in Nursing and Health,12(1)
7. Foreman, M. D.(1986).Acute confusional states in hospitalized elderly: A research dilemma.Nursing Research,35(1)
8. Francis, J.(1992).Delirium in older patients.Journal of American Geriatrics Society,40(8)
9. Francis, J., Martin, D., Kapoor, W. N.(1990).A perspective study of delirium in hospitalized elderly.Journal of the American Medical Association,263
10. Inaba-Roland, K. E., Maricle, R. A.(1992).Assessing delirium in the acute care setting.Heart ＆ Lung,21
11. Inouye, S. K.(1994).The dilemma of delirium: Clinical research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients.The American Journal of Medicine,97(3)
12. Johnson, J. C., Kerse, N. M., Gottlieb, G. L., Wanich, C., Sullivan, E., Chen, K.(1992).Prospective vs. retrospective methods of identifying patients with delirium.Journal of American Geriatrics Society,40
13. Kozak-Campbell, C., Hughes, A. A.(1996).The use of functional consequences theory in acutely confused hospitalized elderly.Journal of Gerontological Nursing,22
14. Lincoln, Y., Guba, E.(1985).Naturalistic inquiry.Thousand Oaks, CA:Sage.
15. Lipowski, Z. J.(1990).Delirium: Acute confusional states.New York:Oxford University Press.
16. Marcantonio, E. R., Flacker, J. M., Michaels, M., Resnick, N. M.(2000).Delirium is independency associated with poor functional recovery after hip fracture.Journal of American Geriatrics Society,48
17. Minick, P.(1995).The power of human caring: Early recognition of patient problems.Scholarly Inquiry for Nursing Practice: An International Journal,9(4)
18. Rudberg, M. A., Pompei, P., Foreman, M. D., Ross, R. E., Cassel, C. K.(1997).The nature history of delirium in older hospitalized patients.Age and Aging,26
19. Rummans, T. A., Evans, J. M., Krahn, L. E., Fleming, K. C.(1995).Delirium in elderly patients: Evaluation and management.Mayo Clinic Process,70
20. Schuurmans, M. J., Duursam, S. A., Shortridge-Baggett, L. M.(2001).Early recognition of delirium: Review of the literature.Journal of Clinical Nursing,10(6)
21. Smita, S., Parika, M. D., Chung, F.(1995).Postoperative delirium in the elderly.Anesthesia Analogy,80
22. Smith, M. J., Breitbart, W. S., Platt, M. M.(1995).A critique of instruments and methods to detect, diagnose, and rate delirium.Journal of Pain and Symptom Management,10(1)
23. Strauss, A., Corbin, J.(1998).Basics of qualitative research: Techniques and procedures doe developing Grounded Theory.Thousand Oaks, CA:SAGE Publications, Inc..
24. Sullivan-Marx, E. M.(1994).Delirium and physical restraint in the hospitalized elderly.Image: Journal of Nursing Scholarship,26(4)
25. Vermeersch, P. E. H.(1990).The clinical assessment of confusion - A.Applied Nursing Research,3(3)
26. Wolanin, M. O.(1977).Confusion study: Use of grounded theory as methodology.Community Nursing Research,8
27. 吳麗芬 Wu, Li-Fen(1995)。護理人員對急性混亂的感知 Nurses' perception of acute confusion。護理研究 The Journal of Nursing Research，3(1)
28. 戴玉慈 Dai, Yu-Tzu, 羅美芳 Lou, Meei-Fang, 葉炳強 , Huang, Guey-Shiun(2000).Risk factors and incidence of postoperative delirium in elderly Chinese patients.Gerontology,46(1)
29. 羅美芳 Lou, Meei-Fang(2001).USA,University of Washington.

1. 蕭淑代、黎書亮、潘潔馨、葉昌振、何牧行(2019)。重症譫妄預測模型於加護病房之應用。榮總護理，36(3)，222-228。