運用Watson關懷理論於一位塵爆燒燙傷病人之護理經驗

Nursing Experience with One Scald Burn Patient of Dust Explosion by Watson's Caring Theory

洪誼婷(Yi-Ting Hung) ； 林心怡(Hsin-Yi Lin)

《彰化護理》 25卷3期 (2018/09) Pp. 67-80

https://doi.org/10.6647/CN.201809_25(3).0010

摘要

大面積燒傷是一嚴重創傷且具生命威脅，初期需要積極醫療處置以維持生命，接續所要面對的而是長時間的復健，此過程中會面臨許多挑戰。本文敘述一位歷經八仙塵爆事件燒燙傷病人之護理經驗，身上多處二到三度燒燙傷，TBSA高達61%，個案經歷了生死關頭及身體傷痛，心中的恐懼與害怕難以抹滅，因此筆者於2015年8月10日至2015年10月9日之護理期間運用整體性評估收集資料，確立個案護理問題為：急性疼痛、身體活動功能障礙、潛在危險性創傷後症候群。筆者運用Watson十項關懷照護理論，以人性關懷為護理服務的核心，並結合Levinas、Logstrup及Rumi三位哲學家觀點，以此理念在護理中實踐，針對問題擬定護理計畫，給予個別性護理措施。看著個案經歷了八仙塵爆事件，從急性期傷口劇烈疼痛及參雜許多負向情緒到接納自己外觀改變，並且用正向樂觀態度勇敢面對，個案這一路上的轉變，從中見證及學習了生命的韌性，筆者也與個案一同成長，期望能藉由此照顧經驗分享，提供臨床照護上之參考。

關鍵字

燒燙傷 ； 身體活動功能障礙 ； 潛在危險性創傷症候群

並列摘要

Extensive burn is a kind of severe trauma and it threatens life. At early stage, it requires constructive medical treatment to maintain life. Subsequently, there will be long-term rehabilitation and significant challenge in the process. This study describes the nursing experience with one patient of scald burns in Dust Explosion Incident at Formosa Fun Coast Water Parks. The patient had partial-thickness and three-degree scald burns on the body and TBSA was high as 61%. The case experienced the crisis of life and physical pains and the fear was permanent. Thus, during the nursing process from August 10 to October 9, 2015, the author collected data by overall evaluation and validated the case's nursing problem below: acute pain, physical activity dysfunction and potential dangerous traumatic disorder. The author applied Watson's Caring Theory often cares and treated human concern as the core of nursing service. This study combined perspectives of three philosophers Levinas, Logstrup, and Rumi and practiced the concept in nursing. The author established nursing plan regarding the problems and provided individual nursing measures. The case experienced Dust Explosion Incident at Formosa Fun Coast Water Park, changed from severe pain of wounds at acute period, negative emotion to acceptance of the appearance with positive and optimistic attitude. In the process, the case witnessed and learned the toughness of life. The author grew with the case and intended to share this caring experience as the reference of clinical care.

並列關鍵字

scald burns ； physical activity dysfunction ； potential dangerous traumatic disorder

參考文獻

許華真、陳淑芳、徐琬茵、謝生蘭(2017)‧一位因石化氣爆燙傷病人之加護護理經驗‧高雄護理雜誌，34(1)，61-71。

陳生松(2016)‧我是職能治療師，燒傷復健路上我陪你‧護理雜誌，63(1)，42-48。

?慧敏(2016)‧迎向生命的曙光—淺談八仙塵爆事件‧護理雜誌，63(1)，17-21。

Gullick, J. G., Taggart, S. B., Johnston, R. A., & Ko, N. (2014). The trauma bubble: patient and family experience of serious burn injury. Journal of Burn Care & Research, 35(6), e413-e427.

Kagan, R. J., Peck, M. D., Ahrenholz, D. H., Hickerson, W. L., Holmes IV, J., Korentager, R., . . . Kotoski, G. (2013). Surgical management of the burn wound and use of skin substitutes: an expert panel white paper. Journal of Burn Care & Research, 34(2),