- 期刊
照顧一位重大事故創傷壓力症候群青少年之護理經驗
Nursing experience of a teenager with major accident induced PTSD
摘要
本文探討一位探13歲青少年因交通事故導致雙側骨盆骨折，與手術後身心巨大改變的衝擊，併發創傷後壓力症候群之護理經驗，護理期間為2018年10月21日至11月14日。通過全人照護評估模式，運用觀察、直接照顧和會談，確定有個案健康問題有急性疼痛、身體活動功能障礙、創傷後壓力症候群及身體心像紊亂。在護理過程中，感同身受突如其來重創，個案正值青少年發展階段危機，藉由跨團隊合作策略，處理急性疼痛，採用藥物和非藥物療法，並根據個案興趣通過觀賞舞蹈短片來分散注意力，在更換傷口敷料時，採取輕柔動作減少刺激，降低疼痛感並減緩焦慮；處理身體活動功能障礙，進行早期功能復健，制定康復計劃，包括被動和主動關節活動、耐力和力量訓練，逐步恢復正常功能；針對創傷後壓力症候群，醫療團隊提供心理和家庭支持，建立信任關係，並鼓勵家庭參與照護活動以增強生活控制感；通過心理諮商，使個案能面對創傷事件，勇於表達自我內心感受，正向思考，積極配合治療及復健，增加自我認同與壓力因應能力，進而達到身心自我調適之穩定康復。期望藉此分享，為未來照護類似個案提供參考，提升整體照護品質，持續優化全人照護概念，有助於提升康復成效，促進整體健康與生活質量。
並列摘要
This case study explores the nursing care provided to a 13-year-old patient who suffered bilateral pelvic fractures in a motor vehicle accident, leading to significant physical and psychological changes post-surgery, including posttraumatic stress disorder (PTSD). The care period ranged from October 21 to November 14, 2018. Using a comprehensive care assessment model involving observation, direct care, and interviews, the patients' acute pain, body image disturbance, and PTSD were identified. Throughout the care process, the nursing team demonstrated empathy toward acute trauma, acknowledging the patient's critical stage of development. A collaborative multidisciplinary approach was adopted to address acute pain using both pharmacological and nonpharmacological therapies. Distraction methods, such as watching dance videos aligned with the patient's interests, were utilized. Dressing changes were carried out with gentle movements to minimize stimulation and alleviate pain and anxiety. Early functional rehabilitation was initiated for impaired physical mobility. A holistic rehabilitation plan encompassing passive and active joint exercises and endurance and strength training was devised to gradually restore normal function. In managing PTSD, the healthcare team offered psychological and familial support, fostered a trusting relationship, and involved the family in care activities to empower the patient. Psychological counseling facilitated the patient in processing the traumatic experience, expressing emotions, nurturing a positive mindset, and actively engaging in treatment and rehabilitation. This approach aimed at enhancing self-identity and stress-coping mechanisms, facilitating stable physical and psychological adjustment. Addressing body image disturbance involved helping the patient cultivate a positive body image through supportive dialogs and psychological therapy, alleviating anxiety and distress related to physical changes. These interventions encouraged a positive attitude toward recovery, leading to improved physical and mental well-being. Sharing this experience aims to guide similar patients, enhance care standards, refine holistic care strategies, and improve rehabilitation outcomes, overall health, and quality of life.