一位中年男性再次中風之護理經驗

Nursing Experience of Caring for a Middle-Aged Male with a Second Stroke

戴瑜慧(Yu-Huei Dai)；王維那(Wei-Na Wang)

中年男性 ； 再次中風 ； 自我健康管理 ； Orem Theory ； Middle-aged male ； Orem's Self-Care Theory ； Second stroke ； Self-care management

志為護理-慈濟護理雜誌

20卷6期（2021 / 12 / 01）

107 - 118

繁體中文

本文旨在提升再次中風的中年男性自我健康管理認知及照顧能力，個案於2018年12月第一次診斷暫時性腦中風出院後可恢復正常日常生活，因未規律服用藥物，生活作息不正常，於五個月後再次罹患腦中風，護理期間自2019年5月9日至6月9日，以歐倫自我照顧模式，利用查閱病歷、直接照護、會談及觀察等方式收集資料，確認健康問題為：身體活動功能障礙、自我照顧能力缺失、知識缺失（特定的）及身體心像紊亂，協同物理、職能治療師及家屬擬定個別性復健計畫；藉由多元衛教方式及工具，包含影片、運動音樂、平板電腦測試、實際操作及回覆示教，提高個案參與自我健康管理及復健的積極度並落實於日常生活，建議制定腦中風照護的護理指引，讓護理人員可以依循護理指引提供正確的疾病認知及多元的衛教工具，希冀透過護理經驗的分享，提供照護此類個案之參考。

This article reports strategies that improve self-care management in a middle-aged male patient who suffered a second stroke. The case was diagnosed with temporary stroke in December 2018 and was discharged from the hospital and could resume normal daily life. During the period of care from May 9 to June 9, 2019, Orem's self-care theory was used as the framework for this project, and data were collected from medical record review, care notes, interviews, and observations. Problems identified included functional movement disorder, lower self-care ability, lack of knowledge (specific), and body image disturbance. By coordinating with physical therapists, occupational therapists, and family members, the nurse developed an individualized rehabilitation plan for the patient. Through various health education tools and activities including videos, music, tablet-based tests, practical operations, and teach-back, patient participation in self-care management was improved, and integration of rehabilitation activities into everyday life was also achieved. Adding these strategies to the stroke nursing guideline is recommended for nurses to foster disease awareness and to provide patients with various tools to improve disease outcomes. By reporting this case, we hope that this experience can serve as a reference for nurses caring for patient with a second stroke.

1. 楊文英,李岩恆,吳淑娟,蘇希洵,陳美伶,孫天龍,黃建華(2017)。急性後期中風病人上肢動作缺損與日常生活功能之關聯分析。醫學與健康期刊，6(2)，45-55。
   連結：
2. 蔡惠如,曾詩蘋,王守玉,張瑛瑛,趙玉環(2016)。探討首次腦中風病人初期之調適過程。護理雜誌，63(2)，2-6。
   連結：
3. 錢駿,鍾芷萍(2018)。缺血性腦中風的分類。臨床醫學月刊，81(2)，72-76。
   連結：
4. Hsieh, C. Y.,Su, C. C.,Sung, S. F.,Lin, S. J.,Kao Yang, Y. H.,Lai, E. C.(2019).Taiwan's national health insurance research database: Past and future.Clinical Epidemiology,11(1),349-358.
5. Sung, S. F.,Lai, E. C.,Wu, D. P.,Heish, C. Y.(2017).Previously undiagnosed risk factors and medication nonadherence are prevalent in young adults with first-ever stroke.Pharmacoepidemiology And Drug Safely,26(12),1458-1464.
6. 李怡玲,李世代,曹昭懿,胡名霞(2018)。居家物理治療改善日常生活活動功能之因素分析。物理治療，43(3)，229-246。
7. 邵娸雯,江怡椿,張文典,陳淑雅(2018)。腦中風上肢動作恢復較佳者重返日常生活使用易受心理社會因素影響。物理治療，43(4)，323-324。
8. 詹淑雅,劉芹芳,金繼春(2011)。身體心像紊亂之概念分析。新臺北護理期刊，13(1)，63-72。
9. 臺灣腦中風學會(2020)．腦中風危險因子之一般處理準則﹕高血壓。https://www.stroke.org.tw/GoWeb2/include/index.php?Page=3
10. 臺灣腦中風學會(2020)．腦血管疾病血脂異常治療指引。https://www.stroke.org.tw/GoWeb2/include/index.php?Page=3
11. 衛生福利部疾病管制署(2018)．慢性疾病防治組之腦血管疾病。https://www.hpa.gov.tw/Pages/List.aspx?nodeid=213
12. 鄭建興(2019)。吸菸與戒菸對中風的影響。臺灣中風雜誌，1(2)，127-131。
13. 韓德生,林家瑋,盧璐,蕭名彥,吳爵宏,梁蕙雯,張凱閔,王亭貴,潘信良,張權維(2016)。臺灣腦中風復健治療指引。臺灣復健醫學雜誌，44(1)，1-9。