應用中心方式評估與戲劇治療的角色理論於日間照顧失智症者之護理經驗

A Nursing Experience of Applying the Person-Centered Assessment Method and Role Theory of Drama Therapy for the elder with Dementia at a Day Care Center

失智症者的盛行率隨年齡增長而增加，其病程變化影響失智症者的認知功能及自我照顧能力，加上70%失智症者常合併精神行為異常，此種現象是工作人員及家庭照顧者主要壓力的來源。本文主旨為描述照護一位71歲重度失智症者初次接受日間照顧中心之經驗，照護期間為2018年5月3日至5月30日筆者應用日本推行的「以人為中心評估法」進行評估，在照護過程中，透過個案行為觀察及家屬會談傾聽等方式進行個案需求評估，發現個案照護需求為：一、老化與失智造成認知功能退化。二、轉換照顧環境的調適困難而致精神行為症狀。三、自我照顧能力不足。依照評估結果確立個案照護需求，提供以失智者為中心的照護，過程中亦應用戲劇治療的角色理論與個案建立信任關係，透過扮演過去生活中經歷的角色，協助個案適應新的照護環境，進而協助解決家庭照顧的困境。本文透過「以人為中心評估法」以失智者為中心的照護理念之經驗分享，期許提供為失智症照護人員之參考，以提昇失智者之照護品質。

The prevalence of dementia increases along with the growth of the elderly population. About 70% of the dementia patients have significant behavioral and psychological symptoms of dementia (BPSD), which are the main source of stress for health care providers and family caregivers. The aim of this article was to describe a nursing experience for a 71-year-old woman with severe dementia receiving initial day care center. During the nursing care period from May 3, 2018 to May 30, 2018, the authors applied the method of“person-centered assessment”to assess the nursing care through holistic assessment, patient observation and family interviews. We found that the health problems for the patient included: (a) degeneration of cognitive function which was caused by aging and dementia, (b) Psycho-behavioral symptoms caused by environment change, and (c) inability to perform self-care. Based on the evaluation results, we provided the care for dementia in a day care center, and used the role theory of drama therapy to build up a trust relationship with the case. Employing the role experience in the past, we help the patient get familiar with the new environment, and also help the patient solve the dilemma of family care. In summary, this case report shares an nursing experience with the person-centered assessment method and the concept of person-centered drama therapy on the care of an elder with dementia and her caregivers in order to improve the quality of care for patients with dementia.