活體肝臟移植病人不確定感之照護經驗

A Nursing Experience in a Living-Donor Liver Transplant Patient Experiencing Uncertainty

楊蓉甄(Jung-Chen Yang) ； 林淑媛(Shu-Yuan Lin)

《高雄護理雜誌》 34卷3期 (2017/12) Pp. 128-137

https://doi.org/10.6692/KJN.201712_34(3).0012

摘要

本篇個案報告旨在探討一位活體肝臟移植病人不確定感之照護經驗，接受活體肝臟移植手術病人對於手術及預後會產生不確定感，本篇個案因對於移植手術及預後資訊不熟悉、手術結果之不可預測性及藥物副作用之資訊不熟悉而產生不確定感，經筆者提供不確定感之介入措施後，術後恢復佳、不確定感減輕，並能順利出院。護理期間自2016 年4 月19 日至5 月3 日，筆者運用Mishel 不確定感理論及不確定感量表，配合觀察、會談及病歷查閱方式收集資料，確立個案有不確定感之健康問題，透過提供其圖文並茂的肝臟移植衛教指導手冊，介紹移植病友團體及相關活動訊息，增加其對移植手術的準備度、術後照顧和藥物副作用的知識、提供社會支持等，降低個案的不確定感，促進個案在肝臟移植手術全期及返家後的調適。建議未來能將不確定感納入肝臟移植病人的手術全期評估項目，以利醫護人員即早發現病人有不確定感問題，並主動給予適當措施，增加病人對移植手術及預後的正向調適。

關鍵字

肝臟移植 ； 不確定感理論 ； 不確定感

並列摘要

The aim of this case study is to describe a nursing care experience in a living-donor liver transplant patient expressing uncertainty. Living-donor liver transplant patients often feel uncertain regarding the surgery and prognosis. This case felt uncertainty because she was not familiar with information about the course of living-donor liver transplantation and was worried about surgical outcome and drug side effects. Through the author implementing intervention for uncertainty, the patient had good recovery with decreased uncertainty, and was discharged from hospital. The period of caring for this patient was from April 19 to May 3 in 2016, when Mishel uncertainty theory and Mishel Uncertainty in Illness Scale (MUIS) were used. Through observation, interview and review of medical records, the patient was assessed to have uncertainty. By providing a colorful information guidebook, introducing the transplant support group and giving related activity information, the patient had increased her preparation for transplant surgery, knowledge about management of post-surgery, side effects of medications, and social support. The patient reduced her uncertainty and increased her adaptation after transplant surgery, and was then discharged from hospital. Conducting uncertainty assessment during the peri-operation phase for living-donor liver transplant patients is recommended because early identification of uncertainty will lead to implementation of appropriate interventions to increase the patient's positive adaptation regarding the transplant surgery and prognosis.

並列關鍵字

Liver transplant ； Uncertainty theory ； Uncertainty

參考文獻

方婷臬、林秋菊(2016)．運用Mishel's不確定感理論於一位活體腎移植病人術後之護理經驗．護理雜誌，63(1)，125-130。

任秀如(2012)．手術全期護理．醫療品質雜誌，6(3)，27-30。

呂冠逸、黃翠媛(2014)．運用Mishel不確定感理論於初次中風個案之護理經驗．長庚護理，25(2)，223-230。

吳佳蓁、翁麗雀、張綺芬、鄭隆賓(2002)．肝臟移植手術後病人生活品質之初探．長庚護理，13(3)，193-203。

翁麗雀、黃秀梨、張嘉玲、郭梅珍(2009)．活體肝臟移植的決策經驗．護理雜誌，56(4)，89-93。