一位頸椎損傷患者之照護經驗

A Nursing Experience for a Patient with Cervical Spinal Injury

本篇是運用紐曼系統性模式，探討一位頸椎損傷合併呼吸器依賴個案生理、心理及家庭社會層面之問題。筆者於呼吸照護中心藉由觀察、會談方式收集資料，分析歸納出個案有呼吸器戒斷反應功能失常、無望感及主要照顧者角色緊張之護理問題。筆者與個案建立信任的護病關係，提供個別性的護理措施，並結合醫療團隊，包含醫師、呼吸治療師，有計畫的執行呼吸器脫離訓練並協助個案使用發聲器，以利表達心裡感受；且教導案妻照護技巧，增加其參與度，幫助個案及家屬面對壓力。同時轉介出院準備小組提供醫院內、外資源，幫助家屬解決後續照護問題，讓個案獲得適當的照護，也讓家屬有良好的生活品質。

Using Neuman System Model, the author probes a ventilator-dependent patient's care needs in physical, physiological and psychosocial aspects. The patient was a survivor of a cervical spinal injury. The author collected data through patient observation and interview in the respiratory care center of a hospital. Data was analyzed and the results indicated three major nursing problems: failure of ventilator weaning-off, hopelessness and the primary caregiver's role tension. The author established trustworthy rapport with the patient first prior to provision with individualized nursing interventions. Collaborating with the medical team including physicians and respiratory therapists, a planned training to wean off the ventilator was implemented. The patient was taught use of a speaking valve to help with verbal expression of his feelings. The patient's wife was instructed care-related skills to facilitate her participation in patient care after patient discharge. In the meanwhile, a post-hospitalization referral was made to the home care team to relieve some pressure the patient with the family might face. With the home care team's follow-up and provision of resources, the patient obtained adequate care and the family had good quality of life as well.