應用以家庭為中心之照護模式於急性腦中風病患及其家庭照顧者轉銜期之照護成效

腦中風為成人殘障及國人重要死因之一，對個人、家庭、和社會產生嚴重的衝擊與負擔。個案管理師為照護團隊與患者及家屬間溝通的橋樑，提供連續性的服務與品質。於急性腦中風轉銜過程中，所採行之個案管理模式應從醫院涵蓋至社區模式。本研究之目的為探討應用以家庭為中心之照護模式是否能夠提昇急性腦中風住院病患及其家庭照顧者於轉銜期之需求滿意度。 本研究為一類實驗性兩組前後測設計。研究場所為中部某醫學中心之腦中風病房，收集144位急性梗塞型腦中風病患及其家庭照顧者為研究對象。於入院第三天醫療狀況穩定後，徵詢同意並簽署同意書後進行前測評分。依隔週輪流分配，單週入者採「常規照護模式」列為控制組；雙週入者採「以家庭為中心之照護模式（family-centered care, FCC）」作為實驗組，介入期間為期五天並做後測評分。「以家庭為中心之照護模式」係指個管師以個案、照顧者、經濟、環境這四個面向來評估其需求而擬定照護計劃，引導病患及家屬共同參與討論計畫決策。透過跨團隊溝通與協調，依個別性給予契合其家庭需求之護理指導及提供相關照護資源。以「腦中風病人及其家庭照顧者滿意度問卷量表」來評值介入成效。以SPSS 21.0統計套裝軟體進行資料分析，統計方法包括次數、百分比、平均值、標準差、卡方檢定、配對樣本t檢、獨立樣本t檢定。 研究結果顯示兩組腦中風病患及照顧者之基本屬性資料同質性高，均無顯著差異(p> .05)。獨立樣本t檢定顯示不管腦中風病患或照顧者對前測的需求滿意度兩組間無顯著差異(p> .05)；配對樣本t檢定顯示兩組腦中風病患與照顧者對後測需求滿意度都顯著高於前測(p< .05)，但獨立樣本t檢定顯示實驗組對後測需求滿意度顯著高於控制組(p< .05)。 本研究結果發現不管是腦中風病患或照顧者採FCC照護模式的需求滿意度比採常規照護模式的需求滿意度高。於轉銜期之照護除了應考量患者的需求之外，家庭照顧者的需求也是不容忽視。在21世紀的管理模式著重於照護協調能力，而個案管理師是腦中風健康照護團隊的靈魂人物。因此，在病人住院期間應以個案及其家庭為中心思考來評估需求，提供相關照護資源，對內主動協助連結各科服務，對外做轉銜作業協調與安排，進而提升患者的照護品質與滿足家屬之需求，減輕家庭負荷。此研究結果期望能提供未來腦中風臨床照護或作為將來相關政策制訂、推動與管理之參考。

Background: Stroke is the main cause of adult disability and it is the fourth leading cause of death in Taiwan. Stroke has a significant impact on individuals, families and society that has a huge economic impact and burden. Aims: The research purpose was to explore whether family-centered care (FCC) model can enhance the need satisfaction of patients and their family caregivers during acute stroke transition period. Methods: This is a quasi-experimental design in a stroke ward of a medical center in Central Taiwan. We included acute ischemic stroke patients and allocated these cases into two groups: Group of conventional care (GCC) and FCC. Intervention time was five days. FCC is a multi-sectoral, collaborative decision making process that provides individualized care based on the needs of each case, caregiver, economy, and environmental condition. Total of 144 patients and their family caregivers were included in the study. We used questionnaire of “Satisfaction scale of stroke patient and their family caregiver " to assess the effect. Used the descriptive and inferential statistics for the results. The significance level was set as p ≤ .05.Results: The results showed the stroke patients and their family caregivers had no significant difference in pre-tested satisfaction between the two groups. Both groups of stroke patients and their family caregivers were significantly higher need satisfaction with the post-test. However, the experimental group had significantly higher need satisfaction with the post-test than the control group.Conclusions: The study was expected to prove FCC is a better care model for stroke patients and their caregivers, and provide important information on the policy development, promotion and management.