運用全人關懷於上肢創傷性截肢個案到院前急症照護經驗

Caring for a Patient with Traumatic Amputation through a Holistic Care Approach

創傷性截肢是突發意外的重大創傷，對個案的身心及社會功能造成巨大的衝擊，此時即時的關懷護理行為對個案身心靈具有很大的支持；本文為運用全人關懷理念，自到院前照護一位52歲左臂創傷性截肢男性個案的經驗。照護期間為2012年09月12日，從事故現場陪伴個案自到院前到急診的急症照護過程。經由直接照護過程，採觀察、身體評估及會談技巧，對個案進行生理、心理、社會、靈性及發展五構面的全人健康評估，歸納出主要健康問題有：「低血量性休克」、「急性疼痛」、「左上肢斷肢組織灌流改變」、「創傷組織高危險性感染」及「焦慮」。全人關懷護理措施包括：評估個案需求及健康問題，運用護理專業技能，維持生命徵象穩定、降低傷口和斷肢感染及減輕疼痛，並提供相關訊息及指導，以增加個案認知及自我解決問題能力的操作性關懷護理；運用正向情緒支持及持續陪伴直到家屬抵達，以減輕個案內心焦慮的表達性關懷護理；經由提供人性化與整體的照護，使個案到院後順利進行斷肢接合手術及降低合併症發生。期望藉此護理經驗分享，提供護理人員對嚴重創傷個案全人關懷的急症照護參酌。

Traumatic amputation, a sudden and unexpected major form of trauma, results in catastrophic impacts on the physical, psychological, and social functions of the victim. The holistic care approach provides the victim with needed support. This article describes a nursing experience of caring for a 52-year male with left arm traumatic amputation. The nursing care period started from the happening of the incident on September 12, 2012 and continued through the patient's stay in the Emergency Department of the hospital. During this period, following a direct care process, the author assessed the patient's health needs in physical, emotional, social, spiritual, and developmental aspects through observation, physical assessment, and interview. The major health problems were hypovolemic shock, acute pain, perfusion changes in the left upper stump, a high risk of infection at the traumatic limb, and anxiety. The holistic care approach includes operational care interventions, such as assessment of the patient's health needs and health problems, application of professional nursing skills, stabilization of the patient's vital signs, reduction of the risk of limb infection and pain, and provision of related information and guidance to increase the patient's awareness and problem-resolving ability. Additionally, holistic nursing offers expressive caring measures, such as being present with the patient to relieve the patient's inner anxiety through positive emotional support until the family members' arrival. Through a humane and holistic nursing approach, the patient was able to smoothly undergo the operation of severed limb replantation and reduce post-operational complications. The author would like to share this article with other nursing professionals providing emergent nursing care for severe traumatic victims using a holistic care approach.