照顧一位癲癇發作導致雙重失能病患之護理經驗

A Nursing Experience of Patient with Multiple Disabilities after Status Epilepsy

江砡伶(Yu-Lin Chiang)；顏玉雯(Yu-Wen Yen)；李碧娥(Bih-O Lee)

癲癇 ； 身體功能活動障礙 ； 焦慮 ； 家庭因應能力 ； 護理經驗 ； epilepsy ； physical disability ； anxiety ； ineffective family coping ； nursing experience

嘉基護理

15卷1期（2015 / 06 / 01）

28 - 38

繁體中文

本文為一位多次癲癇發作個案，造成左側肢體無力及語言表達能力障礙，面臨生理、心理、社會問題之護理經驗。護理期間為：2014年6月8日～6月20日，藉由觀察、會談、身體評估等方式收集資料，以生理、心理、社會及靈性四層面整體性評估，確立個案的健康問題為：「身體活動功能障礙」、「焦慮」與「家庭因應能力失調」等。透過指導案母半側偏癱照護技巧，協助個案漸進式關節活動以預防壓瘡及肢體攣縮，協助盡早下床活動。在案母的協助下運用陪伴、傾聽及同理心，使個案突破心房建立良好的護病關係，期間針對個案的個別性自製圖片與字卡來協助溝通，使個案能主動抒發負向情緒改善焦慮問題。案母也在護理人員的幫助下增強家庭成員的凝聚力，並透過病友家屬的相互扶持及經驗分享獲得心靈上的慰藉。同時社工人員協助申請更多社會資源也為個案家庭經濟壓力減輕不少。護理措施介入後，成功協助個案面對疾病所造成的身心衝擊，重新面對與適應未來的生活，期望藉此個案照護經驗分享，提供臨床照護之應用。

In the case report, the author presented the nursing experience for a patient with left hemiplegia and aphasia resulting from status epilepticu. The patient suffered from the health problems in physical, psychological and social activity. The duration of nursing care was between 8th and 20th, in June 2014. Data collected were the clinical data from observation, communications and physical examination to evaluate patient's physical, psychological and social activity. Three patient's health problems were identified including physical disability, anxiety and ineffective family coping. The author educated patient's mother to improve her joint motion, to prevent decubitus ulcers and limbs retraction, to enhance the daily activity by using special nursing techniques for patient's hemiplegia. After her mother accompanying her, listening to her with empathy, the patient did not defend our nursing care progressively and then the author could create a more stable nurse-patient relationship. Personally homemade word-cards or pictures were used for the communications between patient and us during this period; patient could relax and stop the negative thought and anxiety by this way. After the author's help, her family got closer interaction and consolations by the experience sharing and mental support from other patients' familial communications. Social workers in the hospital also searched more resources to improve her economic condition. After induction of the nursing coping, the author successfully helped this patient to resolve the attacks from the neurological disease, and to adapt himself to the new condition and future life. This was a feasible nursing experience sharing for the clinical practice.

1. Khalid, A.,Aslam, N.(2011).Psychological distress among patients with epilepsy.Indian Journal of Psychological Medicine,33(1),45-48.
2. Mahboubeh, S.,Zeynab, P.,Zahra, A.(2010).Mental health analysis and stress coping strategies in families caring for patients with epilepsy referring to Iranian Association of Epilepsy.Medical Sciences Journal of Islamic Azad University Tehran Medical Branch,20(3),194-198.
3. McFarland, G. K.,McFarlane, E.A.,周幸生（譯）,歐嘉美（譯）,蔡素華（譯）,康百淑（譯）,葉明珍（譯）,張秉宜（譯）,白司麥（譯）,程仁慧（譯）(2008).新臨床護理診斷.台北市:華杏.
4. Rafael, F.,Houinato, D.,Nubukpo, P.,Dubreui, C.M.,Tran, D.S.,Odermatt, P.(2010).Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin.Epliepsia,51(6),1061-1068.
5. 李佳薇,黃莉媛,葉素娥(2014)。運用 Watson關懷理論照顧一位腦瘤復發病人之護理經驗。長庚護理，25(3)，364-373。
6. 岩雪樺,高啓雯(2014)。癌症病人復健之臨床護理實務。長庚護理，25(1)，35-41。
7. 林玉純,林雅蘋(2008)。運用 Watson 關懷理論照護重症患者之主要照顧者護理經驗。醫護專欄，9(1)，89-101。
8. 胡月娟（校閱）(2012).內位科護理學.台北市:華杏.
9. 曹玉芳,薛雅雯,鍾玉珠(2013)。‧一位酒精性肝炎患者及性癲癇發作之急診護理經驗。領導護理雜誌，14(1)，56-67。
10. 連倚南,洪章仁,賴金鑫,王顏和,王亭貴,畢柳鶯,陳適卿,陳嘉玲,黃美涓,黃茂雄,詹瑞琪,蔡文鐘,鄧復旦,謝霖芬(2013).復健及物理醫學.台北市:合記.
11. 陳巧芳(2010)。協助一位主要照顧者降低壓力源之護理經驗。護理雜誌，57(2)，81-86。
12. 陳秀蓉,康宜靜,張明裕,楊惠娟,謝孟蓁(2012)。癲癇學童父母親壓力知覺與社會支持相關性探討。台灣醫學雜誌，16(4)，350-357。
13. 曾元孚(2012)。認識癲癇。台北市醫師公會會刊，56(8)，20-24。
14. 葉美玉,梁淑華(2007)。自我管理計劃對癲癇患者的成效。健康促進暨衛生教育雜誌，27，47-62。
15. 鄭淑文,盧彩屏(2011)。一位急性炎性脫髓鞘多神經病變病人之護理經驗。長庚科技學刊，14，47-56。
16. 蕭佳莉,邱啟潤(2011)。居家照護病患之主要照顧者正負向照顧經驗及其相關因素之探討。護理暨健康照護研究，7(2)，127-139。