- 期刊
- Ahead-of-Print
運用羅氏適應模式於一位脊髓損傷後自殺個案之護理經驗
A Nursing Experience Based on Roy Adaptation Model in a Client Has Suicide After Spinal Cord Injury
摘要
本篇描述一位90歲脊髓損傷男性個案，因無法忍受脊髓損傷造成之疼痛、肢體活動受限而喪失自我照顧能力，飽受生、心理之苦，於案子出門時選擇割腕自殺而入院之護理經驗。筆者自2020年5月31日至6月30日照顧期間，透過觀察、會談、傾聽、直接照顧評估等方式收集相關資料，運用羅氏適應模式評估依急迫性優先處理個案急性疼痛、無望感及家庭因應能力失調等健康問題，照護過程中運用疼痛控制技巧，以期望能在最小副作用下取得最大疼痛緩解。面對無望感併自殺之個案，使用簡式健康量表密切評估自殺意念及嚴重度變化，並及早介入處置，引導個案抒發情緒、肯定自我存在的意義，避免再次自殺。同時透過家庭會談並加入家庭成員表達真實且正向的鼓勵，增強家庭支持系統，強化正向回饋機制，使個案感受被尊重與關懷，協助面對疾病所造成的影響，提升因應能力與日常生活品質，促使個案及家庭能獲得持續性的支持與照護。建議列入護理人員交班，在評估到個案屬於自殺高危險族群時，可自動連結會診精神科醫師以及轉入病房時自動警訊，期望能使醫護人員及家屬及早發現與重視個案正釋出的危機警訊，並避免再度發生，期望藉此個案照護經驗分享，提供臨床照護之應用。
並列摘要
This article describes the use of the Roy Adaptation Model in the care of a client who committed suicide after suffering from physiological and mental alternations caused by a spinal cord injury (SCI). During the nursing care period from May 31 to June 30, 2020, the author evaluated the client by observation, interview, listening, and direct care. Also, we accessed the client with Roy Adaptation Model and then prioritized issues based on urgencies such as acute pain, hopelessness, and disability of the family's coping skills. We expected to achieve maximum pain relief with fewer adverse effects in the process. Otherwise, while tending to the client suffering from hopelessness and a suicide attempt, we need to assess the alternation between suicidal ideation and severity. During family counseling, we allowed the client and caregiver to express their emotion and positive encouragement. Thus, we can improve the family's coping skills so that the client can receive continuous support and keeping. Finally, we suggest the primary nurse can make a proper handoff for this kind of case; thus, we can intervene in the early phases, alert the psychiatrist, and even value the crisis warning that the client has passed.