一位皮膚多處潰爛合併低血鉀遊民之急診護理經驗

本文旨在敘述一位皮膚多處潰爛合併低血鉀遊民在急診室之護理經驗，照護期間自2014年6月30日至7月8日，以Gorden十一項健康功能型態為評估架構，運用直接護理、身體評估、觀察、會談及傾聽等技巧收集資料，經由分析確立個案有現存危險性感染、疼痛、潛在危險性傷害及個人因應能力失調等護理問題。照護期間運用治療性人際關係與個案建立良好護病關係後，根據個案所需提供濕敷法換藥技術照護皮膚傷口、教導使用放鬆技巧緩解疼痛、維持安全舒適環境與密切監測心律變化避免傷害發生、鼓勵個案表達內心感受，傾聽接納並教導壓力調適方法，提升個案自信心，重建對生命的希望感及自我照顧意願。另藉由醫療團隊的介入，運用社會資源聯繫相關機構安置，使個案獲得適當且持續性的照顧，協助個案早日重返健康、正常的生活。因假日及夜間無社工人員上班，遊民安置被延宕，建議醫院社工人力配置能納入考量，縮短遊民冗長的安置程序，讓緊急照護及床位資源得以適當運用。

關鍵字

潰爛傷口；低血鉀；遊民

並列摘要

The aim of this article is to describe the nursing care experience of a homeless patient with multiple skin ulcers and hypokalemia in the emergency department. The period of nursing care ran from June 30 through July 8, 2015. The patient was evaluated with Gordon's eleven health functions evaluation by direct nursing care, physical examination, observation, conversation, and listening skills. Four nursing problems were determined, including infection, pain, potentially self-harm, and poor adjustment ability. During the clinical nursing period, we established a good interpersonal relationship with the patient. We provided wet dressing for wound care and taught relaxation techniques to relieve his pain. We also offered a comfortable environment with cardiac monitor for observation. After that, we listened to the patient's experience and encouraged him to express his feelings in order to enhance patient's confidence for improved self- care ability. We also offered medical team services and social resources for continued care and to assist the patient to return to a healthy and normal life as soon as possible. Lastly, due to no social workers are available at night and on holidays, we recommend the hospital to consider the allocation of social workers in order to solve the problem of resettlement of homeless patients in a timely fashion for a more efficient use of emergency department resources.