Community-Based Nursing Care for Highly Dependent Patients with Intracerebral Hemorrhage : A case study.

Abstract

      This study is a case study aimed at developing the capacity of caregivers and family members to provide correct, safe, and continuous care for patients. The study applied Dorothea Orem’s nursing theory together with the concept of bedridden patient care in managing a patient with intracerebral hemorrhage who had a high level of dependency in the community. The patient was selected from the Continuity of Care (COC) follow-up system, and one patient with complicated problems from Pattaya Bhattamakun Hospital was included in the study. Patient assessment was conducted using Gordon's Functional Health Patterns (11 patterns) and the Barthel ADL Index. Nursing care was implemented using the nursing process together with the concept of home-based patient care to assess problems, plan interventions, implement care, and evaluate outcomes while adjusting the care plan according to the patient’s condition.

      The results showed that the patient was a 52-year-old woman who experienced a motorcycle accident on August 5, 2025. She had decreased consciousness and required endotracheal intubation, followed by a tracheostomy. She was diagnosed with epidural hematoma in the right frontal lobe. Later, a severe pressure ulcer developed at the coccyx area. The patient was hospitalized for 49 days before being discharged home. At discharge, her level of consciousness had improved but she still had confusion and poor behavioral control, left arm weakness, a tracheostomy wound, a nasogastric feeding tube, and a urinary catheter. She was classified as a highly dependent patient and was referred to the home Continuity of Care system. A care plan was developed and regular home visits were conducted. The patient gradually improved: cognitive function returned to normal, she was able to follow commands, became more independent in self-care, could sit up independently, eat by herself, had no further complications, and the pressure ulcer decreased in size.