- 期刊
協助一位遭火車撞擊青年渡過創傷反應之加護照護經驗
Intensive Care Experience of a Youth People from the Post Traumatic Response of a Train Crash
摘要
當創傷發生在急性照護期，臨床多半以恢復生理機能為優先，常忽略創傷事件帶給病人的心理反應，除了造成身體上極大的衝擊，心理創傷更難以抹滅。協助病人渡過嚴重創傷後衍生之身、心健康問題。本個報運用Gordon十一項健康功能型態評估作為指引，進行健康功能型態分析，作為收集資料、判斷病人健康問題、確立護理診斷之參考架構。透過直接照護、觀察、紙筆訪談、身體評估及查閱病歷等方式收集資料，分析、歸納主要健康問題為：急性疼痛、創傷後反應、呼吸器戒斷反應、睡眠型態紊亂、身體活動功能障礙、身體心像紊亂。依病人所需之輕重緩急處理排序為急性疼痛、創傷後反應、呼吸器戒斷反應。透過藥物及個別性疼痛緩解措施，讓病人疼痛減輕，並於護理過程主動關懷及傾聽，陪伴渡過恐懼、哭泣及憂鬱情緒，給予肯定等個別性照護計畫，漸而降低恐慌及呼吸困難之感受，藉由分享嚴重創傷個案成功脫離呼吸器且痊癒出院案例，運用跨領域醫護團隊合作照護模式、採用筆談溝通、耐心鼓勵病人寫出心中想法，並認同其感受，增進正向的心理感受，以正視身體結構之改變，強化自我心理照護能力，成功克服創傷後反應。
並列摘要
When the trauma occurred during the acute care period, most clinical to restore physiological function as the priority, often ignore the traumatic event brings to the patient's psychological reaction, in addition to cause great impact on the body, psychological trauma is more difficult to erase, so that spiritual care has in-depth understanding of necessity. This case report used an eleven Gordon's health function status assessment as a guide. Data were collected through direct care, observation, paper-pen interviews, physical assessment and medical history review to analyze and summarize the main health problems: acute pain, post-traumatic stress, ventilator withdrawal, sleep disorders, physical activity dysfunction, and body image disorders. To rank the nursing problems according to priority as acute pain, post-traumatic stress, respiratory withdrawal response. Through medication and pain relief measures, his pain is alleviated. The intensive nurse take the initiative to care and listening during the nursing process, accompanies crossed the fear, the sob and the melancholy mood, giving affirmation and other individual care plans, and gradually reduce the feeling of panic and difficulty breathing. And share successful cases of successful respirator detachment and severe trauma cases, use the care model of cross-disciplinary medical team cooperation, patiently use written conversations to encourage cases to write their thoughts and agree with their feelings, enhance positive psychological feelings, and face the body structure Change and overcome post-traumatic reactions and strengthen self-psychological care.