照顧一位創傷性手指截肢個案之護理經驗

本文主在探討一位36歲青壯年因工作不慎導致左手2、3、4指斷指，面臨重建失敗而行截肢手術，在照護過程中的護理經驗。筆者於2018年08月12日至08月18日的照護期間運用Gordon十一項功能性健康型態模式評估，透過實際照護、觀察、會談、身體評估及病歷查閱方式收集資料，了解個案身體、心理及靈性等層面以確立個案之健康問題：1.疼痛／與截肢手術傷口及幻肢痛有關、2.自我照顧能力缺失／與無法自行進食、穿衣、沐浴有關、3.無望感／與擔心手指截肢影響工作而無經濟收入有關。筆者藉由護理過程中除了協助個案解決生理上的問題也注重其心理問題，透過主動關懷、引導其表達內心感受、鼓勵家人陪伴、建立信任感、協同社工尋找資源以提供個別性護理，協助重拾自我價值，提升自我照顧能力，重建正向自我概念以利重返社會。

關鍵字

斷指重建；截肢；無望感

並列摘要

This article is to explore the nursing experience of a 36-year-old adult who was facing the amputation surgery after the failure of reconstruction operation due to the left hand 2nd, 3rd, and 4th Digit injury .During the care period from August 12 to August 18, 2018, the author used Gordon's eleven functional health model assessments to collect information through actual care, observation, interviews, physical assessment and medical record review. Psychological and spiritual aspects to establish the health problems of the case: 1.Pain/related to amputation surgery and phantom limb pain, 2.Loss of self-care ability/related to self-feeding, dressing,and bathing, 3.Hopelessness/and Worried that finger amputation would affect work and loss the economic income. In addition to assist the case to solve physiological problems, the author also paid attention to his psychological problems. Through active care, guiding his inner feelings, encouraging family companionship, building trust, and cooperating with social workers to find resources to provide individual care. Pick up self-worth, improve self-care ability, and rebuild positive self-concept to benefit from reintegration.