脊髓損傷個案創傷後的生活經驗與照護需求

脊髓損傷為人生遭遇之重大災難事件，損傷後個案面臨身體殘障、創傷帶來心理衝擊的問題。本研究旨瞭解脊髓損傷個案創傷後生活經驗與照護需求。採現象學研究法，以立意取樣方式，從脊髓損傷協會徵求10 位願意分享經驗之脊髓損傷個案，經其同意後，填妥知情同意書，至個案家中或與其約定訪談地點，利用開放式訪談指引，進行一對一的深度訪談。訪談內容徵求研究對象同意全程錄音，並將所得資料轉為逐字稿；再以內容分析法進行資料分析與歸納。創傷後生活經驗之研究結果可概括四項主題，歸以脊髓損傷的震驚與措手不及：災難瞬間降臨、身體功能喪失的認知不足；面臨脊髓損傷的惶恐與害怕：否認脊髓損傷的事實、期待奇蹟出現；陷入無盡的黑暗：創傷深烙著生命、獨自隱忍痛苦的煎熬、生命秩序的混亂；對生存意義之省思：哀慟過去，試著面對殘障的身體、自我接納及成長等四項經驗主題。而照護需求則分成「家人的接受與支持」、「創傷後的關懷與陪伴」、「提供相關社會福利與經濟補助的訊息」、「居家照顧的訊息與措施」、「明確告知預防壓瘡及尿路感染的重要性與措施」等五個主題。基於本研究結果，建議醫院應將脊髓損傷個案列為個案管理，並整合社會福利資源，協助脊髓損傷個案出院後的居家自我照顧。本研究結果有助於護理人員進一步瞭解脊髓損傷個案之創傷後生活經驗，作為照護之參考。

關鍵字

脊髓損傷；創傷後生活經驗；照護需求

並列摘要

Spinal cord injury as a life experience of a major disaster event, cases face with physical disability, post-traumatic psychological impact caused the problem. This Study was to understand the post-traumatic lived experiences and care needs of cases with spinal cord injury. This was a Phenomenological study that employed purposive sampling to recruit a total of 10 participants, who all provided informed consent. The number and point in time of interviews were determined by each participant's situation. Interviews were conducted one-to-one and in person by the first author. Data were collected using an open interview guide and subject interviews were tape recorded for subsequent coding. Interview content was analyzed and categorized using the content analysis method. Four main themes related to participants' experience included: were shocked and unprepared of spinal cord injury: disaster came sudden unexpectedly, lack of recognition with physical dysfunction; pain and despair of spinal cord injury: denied the fact of spinal cord injury, looked forward a miracle; fall into the dark endless: trauma imprint to the life, forbear pain excruciation alone, the chaos of life; reflections on the meaning of life: mourn for past and try to face of physical disability; self-acceptance and growth. Five main themes related to participants' care needs included: acceptable support from family; companion ship with spinal cord injury cases; provided social welfare and economic support information after spinal cord injury; home care skills; informed the prevention skill of pressure sores and urinary tract infection clearly. Based on study results, we suggest that the hospitals should be classify spinal cord injury cases as case management, and integration of social welfare resources to help spinal cord injury cases, post-discharge care needs. This study offers useful information to nurses responsible for handling post-traumatic experience of cases with spinal cord injury.