運用復原力照護一位重度燒傷病人之加護經驗

Application of Resilience in Caring for a Patient with Major Burn Injury in an Intensive Care Unit

葉韋岑(Wei-Tsen Yeh) ； 林采蓉(Tsai-Rung Lin)

《高雄護理雜誌》 36卷1期 (2019/04) Pp. 117-128

https://doi.org/10.6692/KJN.201904_36(1).0011

摘要

本文主要探討照護一位青壯年病人因工作意外，歷經顏面、前軀幹及雙手重度燒傷面積2～3度23％ TBSA（Total Body Surface Area，TBSA）之加護經驗。照護期間為2017年10月10日至23日整體性評估後，確立病人有（一）組織完整性受損／與燒傷導致真皮層受到破壞有關、（二）急性疼痛／與燒傷導致神經末梢暴露、傷口水療換藥有關、（三）營養狀況少於身體所需／與燒傷病人身體肌肉、熱量和蛋白質流失、傷口疼痛及病人心理因素有關、（四）情境性低自尊／與顏面及雙上肢燒傷傷口造成外觀改變有關等健康問題，生理層面問題與醫師、營養師、物理治療師等照護團隊，共同討論後提供最適切的照護措施；心理層面問題則運用復原力的概念，給予病人充足的社會支持以保持樂觀，使病人能轉以正向態度面對身體外觀的改變，並對未來復健情形秉持著信心。

關鍵字

復原力 ； 重度燒傷 ； 加護經驗

並列摘要

This report describes the nursing experience of caring for a middle-aged man who suffered flame burn injury of 2-3 degree 23% TBSA at work. This injury caused burn wound of the face, anterior trunk, and both right and left hands. Information was collected by physical assessment, direct care, close observation, and interviews. The authors identified the patient's health problem including existing damage, acute pain, insufficient nutrition and situational low self-esteem. The nursing period was from October 10 to October 23 in 2017.With respect to physical problems, we discussed these issues with experts from multiple fields to provide the patient with the most appropriate interventions. As for the mental problems, we used the concept of resilience, giving the patient adequate social support and the ability to have optimistic thinking, thereby accompanying the patient out of the atmosphere of melancholy and low self-esteem. Furthermore, the patient not only faced the change of his appearance, but also became more self-confident on the road of rehabilitation.

並列關鍵字

Resilience ； major burn ； intensive nursing experience

參考文獻

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羅淑芬(2015)‧嚴重燒傷病人護理處置‧護理雜誌，62(4)，82-88。

He, F., Cao, R., Feng, Z., Guan, H., & Peng, J. (2013). The impacts of dispositional optimism and psychological resilience on the subjective well-being of burn patients: A structural equation modeling analysis. Interdisciplinary Research Collection. 8(12), e82938. doi: https://doi.org/10.1371/journal. pone.0082939

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