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

Dysphagia in first-time stroke patient

黃莉雯(Li-Wen Huang)；黃惠滿(Hui-Man Huang)；張薰文(Hsun-Wen Chang)；謝春滿(Chun-Man Hsieh)

腦中風 ； 發音不良 ； 吞嚥困難 ； 關懷照護理論 ； 護理經驗 ； Children and Youth ； Residential Care Experience ； Independent Living

台灣健康照顧研究學刊

27期（2023 / 01 / 01）

42 - 59

繁體中文;英文

本文闡述運用關懷理論於一位初次罹患腦中風造成發音不良（構音困難）及吞嚥困難之中年婦女之門診照護經驗。照護期間為2021年4月18日至5月30日，以觀察、身體評估、病歷查閱、會談及電訪方式收集資料，經四大層面之整體性護理評估後，確立個案有言辭溝通障礙、吞嚥障礙及焦慮三項健康問題。筆者運用Watson關懷照護理論提供個別性整體照護，評估個案語言障礙、吞嚥困難及焦慮程度，同理個案需要充分時間表達且會有多次失誤的情況，鼓勵個案及其家屬加入個案照護治療計畫，藉由重要關係家屬與個案多次且漸進式良性互動（如發音練習、口腔運動及飲食治療），運用肢體動作或圖卡增進溝通能力，調整飲食質地以改善吞嚥困難，提升個案語言、吞嚥復健及日常生活信心，進而改善個案的焦慮程度。期望藉本文照護經驗，提醒醫療照護團隊能篩檢並早期確認腦中風病患健康問題，及早介入預防措施，進而降低個案健康惡化及再住院率。

From the viewpoint of attachment theory, this study aimed to examine whether and how children and youth were affected in relation to their independent living after receiving the residential care service. The methodologies primarily include qualitative methods, then summarized data. The result showed that: First, the experience of residential care service which, by a long period of dynamic interaction with the staff of the institution, gave a home-like interaction along with an attachment relationship to the children and youth accounted for their positive feelings such as warmth and being respected, which subsequently internalized into and were utilized by them to seek for connections with other communities and the society. Secondly, their response strategies and the criteria in choosing thereof could be classified into three aspects; "psychologically," "materially," and "socially"; further, the response strategies which the children and youth chose were substantially affected by their attachment to their resource suppliers. Thirdly, when the children and youth regarded the care homes as safe castles or harbors because of the secure attachment created therein, their attitude towards independent living became more open-minded and adventurous despite some of the inevitable challenges they have to encounter; then transplanting the learned skills from the residential care experience into their adapting to other aspects of life in the society.

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