中西醫結合照護一位高齡髖骨骨折復健期合併無望感之中醫門診護理經驗

Integrative care for an elderly hip fracture rehabilitation of the merger hopelessness of Chinese medicine outpatient care experience

柳宜伶(I-Ling Liu) ； 洪瑞葉(Jui-Yeh Hung)

《中西醫結合護理雜誌》 4期 (2020/11) Pp. 95-105

https://doi.org/10.6211/TTCMNA.202011_(4).0009

摘要

希望是生命的泉源，無望感是主觀認為沒有未來存在；老年人會對生命的意義與價值受到死亡及疾病的威脅，對未來產生負面想法，進而影響生活態度（陸，2015；鄧、徐、陳、蔡、林，2005）。本文旨在探討一位骨折術後復健期因情緒低落而自殘的高齡者，於中醫門診治療期間，協助其身心調適過程。筆者於2017年7月18日至9月30日照護期間，藉由中醫整體性評估（望、聞、問、切）收集個案資料，確立有慢性疼痛、身體活動功能障礙及自我照顧能力缺失等健康問題；在心理層面，因術後造成生活功能之改變而有憤怒、焦慮、害怕等負向情緒，甚至有自殘行為，更有無望感產生。護理過程中透過辨證施護，協助其解決身體上的不適；應用會談、傾聽、關懷、同理心等方式使個案恢復信心；運用繪畫、五行音樂進行情志照護、情志疏導，改善與家人之間的感情並提高生活品質。希望，藉此照護經驗提供護理人員面對高齡長者照護，使個案及照顧者能得到全面且有效的護理照護。建議護理人員面對高齡長者出現情緒不穩、自殘等行為，應審慎評估高齡長者的身心靈各個層面並彰顯護理多樣性與獨特功能，有助於高齡者擁有較高的生活品質。

關鍵字

中西醫結合照護 ； 高齡長者 ； 無望感

並列摘要

Hope is a fountain of life. Hopelessness is the subjective thinking of no future ahead. The meaning and value of life to the elderly is threatened by death and disease. Therefore, they have negative thoughts about the future, which influence their attitude of life. This article aims to explore an elderly fracture surgery rehabilitation period due to depression and self-mutilation, and during outpatient treatment of traditional Chinese medicine to help the process of physical and mental adjust. Author took care of the case from July 18^(th) to September 30^(th) in 2017. During this time author collected case data through the overall assessment of Chinese medicine nursing to confirm that the case had chronic pain, physical activity dysfunction, and lacked of self-care ability and so on health problem. At the psychological level, there were negative emotions such as anger, anxiety, fear, etc, due to changes in life function after surgery, and even self-harm behavior, even more hopeless sense of production. Nursing process through the dialectic nursing helped to resolve physical discomfort. Application of talking, listening, caring, empathy and other ways made a case to restore confidence. Applied painting, five elements of music carried out emotional care, emotional conditioning, improving the relationship with family and improving the quality of life. It is hoped that this care experience will provide caregivers with care for the elderly, and provide comprehensive and effective care for the patients and carers. It is recommended that nursing staff face the behaviors of emotional instability and self-harm in the elderly, it is necessary to carefully assess the physical and mental aspects of the elderly and highlight nursing diversity and unique functions, which will help the elderly to have a higher quality of life.

並列關鍵字

combination of Chinese and Western medicine in caring ； elderly ； hopelessness