照顧一位下肢壓碎傷接受膝上截肢手術患者之護理經驗

本文是探討一位24歲女性，因車禍導致左下肢壓碎傷而接受多次清創、植皮及膝上截肢手術後，在面對創傷、身體功能受損及心理衝擊療程之案例。護理期間自2007年5月30日至2007年7月20日，筆者運用觀察、會談、並以生理、心理、社會、靈性評估模式為指引，發現個案有急性疼痛、身體活動功能障礙、身體心像紊亂、創傷後反應及焦慮等健康問題。在護理過程中以傾聽、主動關懷來接納患者心中感受；建立良好護病關係，解決身體疼痛不適與功能障礙；並在家屬配合下協助患者面對身體心像紊亂之調適；採支持與鼓勵突破心理社會之障礙，再與個案及家人共同討論執行個別性的復健計畫，恢復日常活動能力。希望藉此護理經驗，提供同仁在照護類似病患時，除了減輕其生理不適外，亦要重視並協助解決心理問題，方能完成整體性護理，以達全人照護之目的。

關鍵字

截肢；身體活動障礙；身體心像紊亂

並列摘要

This article describes the nursing process of a twenty-four-year-old female patient who faced trauma, impaired physical function and psychical impact after receiving multiple debridement, free-flap operation and above-knee amputation. The nursing experience happened between May 30 and July 20 in 2007. Both subjective and objective data were collected through communication, interviews and chart reviews. The issues addressed included physical, psychological, social and spiritual aspects of the patient. The identified problems of the patient were acute pain, impaired physical mobility, disturbed body image, post-trauma response and anxiety. During the nursing process, the patient’s pain and impaired physical mobility were both relieved by listening, caring and showing empathy from the author. Support and encouragement were also offered to the patient to face the reality of a change of her body, and to receive attended rehabilitation project for recovery. This nursing experience of holistic care can be valuable to other healthcare professionals. It is expected that the nursing staff would be able to develop adequate nursing intervention skills to help relieving the amputated patients’ physical discomfort, but also to attend the psychological needs of the patients.