- 期刊
照護一位無肛症新生兒之護理經驗
The Nursing Experience in Caring for a Newborn with Imperforate Anus
摘要
本文描述一位新生兒因出生後即發現無肛症，故自診所轉診至本院治療的照護經驗；照護期間自2021年4月17日至2021年4月25日，筆者藉由實際參與照護、整體性身體評估與家庭評估模式等方式收集相關資料，進而分析，確立健康問題有皮膚完整性受損、急性疼痛、照顧者角色緊張，在護理過程中，筆者擬訂個別性照護措施，包含：維持會陰瘻管周圍皮膚完整性、利用非藥物性方式轉移注意力等，以緩解因瘻管擴張術所引起的疼痛；針對照顧者方面，透過傾聽與陪伴並提供社會資源介紹相關支持團體，並設計衛教小本、衛教假娃娃並錄製瘻管擴張術衛教影片，提供案父母返家觀看、複習後再嘗試替個案實際進行瘻管擴張術，過程中並召開家庭會議由跨團隊成員共同提供支持，對返家後照顧技巧亦適時給予修正、鼓勵，以增加照護者對於日後照護的信心，藉此個案建議日後可設立個案管理師，透過專人定期追蹤、關懷，使個案返家後能獲得持續性完整照護，提升整體照護品質。
並列摘要
This article describes the nursing experience in caring for a newborn boy with an imperforate anus and perineal fistula diagnosed after birth and transferred from the local clinic to our hospital. The nursing period was started from April 17 to April 25, 2021. The author collected and analyzed information through direct patient care, comprehensive physical assessment, and family assessment model. Three major nursing problems were identified: 1.Impaired skin integrity due to fistula; 2.Acute pain due to fistula dilatation; and 3.The caregiver's role strain due to the lack of caregiving information. During the hospitalization period, several specific nursing measures were proposed and implemented, including maintaining the skin integrity around the perineal fistula by using non-pharmacologic management, and relieving the symptoms of pain as the result of fistula dilatation. With respect to the caregivers' stress in caring for the newborn, some measures such as listening, companionship and offering practical social resources and support groups, providing well-designed health education books and skill demonstration via dolls and videos related to care of fistula dilatations were made during and after the newborn's hospitalization. After watching and reviewing the education materials at home, the parents were capable of performing fistula dilatations by themselves. Provision of advice, encouragement, medical care skills at home and social support from interdisciplinary team via a family conference, were helpful in improving the caregiver's level of confidence in caregiving. Based on the experience in caring for the newborn with imperforate anus and supporting the parents, the author provides an example of a case management consisted of regular follow-ups with a focus on continuous and comprehensive care when discharged home, which can result in sustaining quality of care for a chronic childhood illness.