以家庭為中心概念照顧一位極低出生體重先天股骨骨折早產兒的照護經驗

Nursing Experience in Caring for a Premature Baby with Congenital Femoral Fracture Based on Family-Centered Care

蔡昕妤(Hsin-Yu Tsia) ； 楊佰能(Bai-Neng Yang)

《馬偕護理雜誌》 13卷2期 (2019/07) Pp. 18-28

https://doi.org/10.29415/JMKN.201907_13(2).0002

摘要

先天性骨折在新生兒是一種罕見的疾病，尤其發生在極低體重早產兒的股骨部位，出生時因妊娠週數不足，身體各系統發展未臻完熟，除穩定生命徵象及避免併發症外，股骨骨折的照護更具挑戰性。本文探討照顧一位先天性股骨骨折、體重僅680公克早產兒的護理經驗，文中首先針對極低出生體重早產兒護理以及先天性股骨骨折的簡介、護理等方面做文獻的探討，透過文獻理論之應用，照護期間自2018年2月18日至4月29日，藉由實際身體檢查、臨床觀察與家屬進行深入會談的評估方式，發現個案因早產產生「氣體交換障礙」，因股骨骨折產生「疼痛」、「身體活動功能障礙」，因早產的衝擊及執行骨折固定術產生「親子依附關係障礙」等健康問題，在經過使用音樂療法、護理指導、心理支持及轉介至出院準備團隊等護理措施，鼓勵家屬參與護理計畫，達成以家庭為中心的護理過程，成功改善其親子依附關係上的困難。最後，個案能順利拔管、疼痛指數由7分下降至0分、骨折固定石膏如期移除且父母能開始接觸、關心個案，故筆者建議可運用以家庭為中心理論於早產兒照護中，以助建立親子依附關係。由於此個案之特殊性在照護上極具挑戰性，希望藉此經驗分享能做為護理同仁在臨床照護上的參考依據。

關鍵字

先天性股骨骨折 ； 音樂療法 ； 以家庭為中心照護 ； 早產兒

並列摘要

Congenital fracture is a disease rarely seen in newborns, especially in extreme low body weight premature baby's femoral bone. Owing to the insufficient gestational age, the body function of the baby remains immature, except for stabilizing the vital sign, the care of femoral fracture is full of challenge either. This article is to discuss the experience of caring for a premature baby weighing 680 grams with congenital femoral fracture. First of all, the author mentioned about the care of premature babies and an introduction of congenital femoral fracture as well as literature discussion. The data was collected from February 18 to April 29, 2018 via physical examination, observation and conversations with the family by the author, which was the chief caregiver during hospitalization. The main problems of this case were as followed: ＂impaired gas exchange＂ as the result of prematurity, ＂painfulness＂ and ＂physical activity disorders＂ due to femoral fracture. As the result of the impact of prematurity and the fixation of fracture, it led to the problem of ＂impaired attachment with the parents＂. Several interventions offered based on a family-centered program, referred to music therapy, nursing instruction, mental support and the team's pre-discharge preparation in encouraging the family to participate in the nursing plan had alleviated the difficulty in the attachachment relationship. The baby was extubated successfully and the score of pain had decreased from 7 to 0. In addition, the removal of the plaster enabled the family to be able to touch the baby. Therefore, the author suggested that the application of family-centered care theory can help establishing the attachment between the family and the baby. As a result of the challenge of caring for such particular case, the author hoped to share the experience as a reference for clinical nursing practice.

並列關鍵字

congenital femoral fracture ； music therapy ； family-centered care ； premature baby