運用Orem理論照護一位多重性骨折病人之護理經驗

A Nursing Experience of Applying Orem's Theory to the Care of a Patient with Multiple Fractures

黃香儒(Hsiang-Ju Huang) ； 雷琇惠(Hsiu-Hui Lei)

《新臺北護理期刊》 17卷1期 (2015/03) Pp. 77-86

https://doi.org/10.6540/NTJN.2015.1.008

摘要

本文旨在分享運用Orem自我照顧理論，協助一位因工作受傷造成多重性骨折的49歲男性，面對生、心理壓力之護理經驗。筆者於2012年5月18日至27日護理期間，透過觀察、身體評估、會談及查閱病歷等方式收集資料，確立個案有急性疼痛、身體活動功能障礙、自我照顧能力缺失、個人因應能力失調等健康問題。照護中先藉由疼痛護理解決個案急性疼痛的問題；再讓個案和家屬了解復健運動的重要性，共同訂定有效的復健計劃，協助持續執行復健運動，及監測其完整性；藉由強化家屬的支持功能、結合社工師、復健護理師等支持系統，早期介入出院準備服務，提供輔具租借服務、經濟舒緩方案，幫助個案面對疾病的生、心、社會衝擊，調適負面情緒，產生正向意念，繼而能早期激發自我照顧的意願，學習出院後的居家自我照顧與復健運動，因而個案能如期出院與適應居家自我照顧生活。冀望藉此護理經驗提供護理同仁在重大創傷病人照護與協助其自我照顧時的參考。

關鍵字

骨折 ； 疼痛 ； 心理影響 ； 自我照顧

並列摘要

This paper describes the nursing experience of applying Orem's self-care theory to a forty-nine-year-old man in facing physiological and psychological impacts resulted from multiple fractures due to an accident at work. During the nursing period from May 18 to 27 in 2012, data were collected through observations, physical assessment, and interviews. The health problems identified included acute pain, impaired physical mobility, self-care deficit, and ineffective coping. The author not only helped the patient to solve the problem of acute pain but also assisted him in understanding the importance of exercise rehabilitation and established an effective rehabilitation program to continuously monitor the integrity of implementation of exercise rehabilitation. We also strengthened the support system from family. Social workers as well as rehabilitation nurses provided early discharge planning to help the patient face the illness and stimulate their willingness to learn self-care skills. This report could provide the nursing staff with reference for similar cases.

並列關鍵字

Fracture ； Pain ； Psychological impact ； Self-care

參考文獻

袁素娟（（2007）‧肌肉骨骼系統疾病之護理‧於劉雪娥總校閱．成人內外科護理（四版，下冊，471-549頁）‧台北：華杏。

張曉昀、何賢貞、林志峰、林政毅（2011）‧六週懸吊系統運動訓練對慢性下背痛患者之療效‧中山醫學雜誌，22（1），43-51。

陳清惠（2008）‧擺位與移位‧於施陳美津總校閱，復健護理（二版二刷，217-231頁）‧台北:華杏。

勞工衛生研究所（2010，12月）‧營造業職災情勢分析‧取自http://www.iosh.gov.tw/Book/Message_Publish.aspx?PID=110&UID=1201&FID=F5859

曾瓊誼、賴美玉（2011）‧一位慢性阻塞性肺疾病成功脫離呼吸器病患的護理經驗‧中山醫學雜誌，22（4），455-464。