本篇個案報告在分享居家護理師協助一位同時照顧臥床母親、重度多重障礙哥哥及年邁父親等三人，長期承擔超過個人能力負荷的照護工作，導致負荷過重、身心疲憊之主要照顧者調適壓力的居家照護經驗。護理期間自97年6月20日至97年9月30日，運用傾聽、關懷、同理心等溝通技巧，與主要照顧者建立信任感與良好護病關係，以家庭評估模式透過家庭訪視、電訪、觀察、會談等方式，收集資料與確立問題，發現主要照顧者之健康問題有：照顧者角色緊張、睡眠型態紊亂、家庭因應能力失調。針對問題之護理重點有二，其一為教導主要照顧者照護技能、壓力調適策略、時間管理及透過家庭會議提供家庭成員協商機會等措施，協助主要照顧者調適負荷，協助家庭照護需求之滿足；其二為整合個案及其家庭適用的地區性社會資源，運用多元團隊，鼓勵主要照顧者善用多元資源，提昇居家照護品質，達到個案管理之持續性照護目標。此一個案係筆者從事居家護理實務工作以來，首次以家庭為照護中心，主要照顧者為照護對象，透過個案管理模式整合社區健康照護系統，協助主要照顧者及其家庭獲得整體性、持續性照護服務，提昇生活品質之難得經驗，希望藉由本個案報告分享的照護歷程，提供長期照護領域之護理專業同仁參考。 Caregiver loading is an important issue in th longterm care system, which maybe induce psychosomatic disease. The purpose of this case report was to describe the nursing experience and effectivenessof implementing case management for a caregiver who caring three disabled families. Through homevisit and telephonevisit, we used observation, interviewing, physical examination, and comprehensive nursing assessment to identify the health problems. Three major health problems wereidentified：strain of careing, disturbed sleep pattern and maladjustment of family. Through authors active caring with sympathy, caring and empathy to establish the relationshipof authors and client, then authors offered interventions from multiple social resources to assist the client to face the impact of caregiver loading in the nursing process. Finally, the clinent’s sleep quality and coping ability were improved, and she applied the supports from families and community. The experience of case management is presented as an example for future care in similar situations.
