應用羅氏適應模式於一位皮爾羅賓氏症案童之護理經驗

Nursing Experience of Applying Roy’s Adaptation Model to Care for a Child with Pierre Robin’s Syndrome

本文主要描述一位皮爾羅賓氏症女童長期氣切留置於兒童加護病房之照護經驗，案童為2 歲5 個月的女孩，因疾病呈現下顎後縮、舌頭後倒導致呼吸困難，自小接受長期留置氣切管及鼻胃管。而案母婚姻關係複雜、無經濟能力撫養案童，由社會局將案童安置於護理之家。近一年多來，因呼吸道感染與多次自拔鼻胃管，反覆插管致使上腸胃道出血，而進出本院兒童加護病房治療多次，長期營養供給不足使得生長發展亦較為遲緩。筆者見案童多次進住加護病房，且多為相同之照護問題，因此引發深入探討其問題，護理期間為101 年1 月1 日至同月23 日，以羅氏適應模式為主要評估工具，經由身體評估、觀察、直接照護、電訪等方式收集相關照護資料，歸納此次住院期間主要的健康問題，包含急性疼痛、呼吸道清除功能失效、潛在危險性創傷、親職功能障礙、感染等。針對其護理問題給予案童相關的個別性措施及照護，運用觀察、傾聽、同理心對案童主動關懷。應用圖畫、製作小飾品、聽音樂、塗鴉等減緩案童對於治療與護理的恐懼，並以擁抱方式安撫情緒與減輕對疼痛的感受。經由醫療團隊包括社工解說，讓母親同意案童執行胃造瘻口術後，經由筆者與其他護理同仁的細心照護，上述護理問題得到改善，並聯繫及教導護理之家的照護人員接續提供照護。筆者經由此次的照護經驗，了解如何運用羅氏適應模式為護理評估工具，提供病童適切性的照護。亦期望藉由此次照顧皮爾羅賓氏症案童的護理經驗，能做為護理人員對未來照護相關案童之參考以提升護理品質。

The aim of this case report is to describe the nursing experience of applying Roy’s adaptation model to care for a child with Pierre Robin’s syndrome and recurrent gastrointestinal bleeding. This 2-year and 5 months old girl suffered from severe mandibular retrognathism, backward tongue position and airway obstruction. Her mother had a complex marital relationship and poor economic status. The child was placed in a nursing home by the Social Welfare Bureau. She revealed minor developmental retardation, received tracheostomy and required a long-term indwelling nasogastric tube. As a result, she had more than a year’s history of repeated extrications of the nasogastric tube and recurrent upper gastrointestinal tract bleeding. We applied Roy’s adaptation model at a pediatric intensive care ward to assess and collect data through physical observation, direct care, and telephone interviews with her mother from January 1 to 23, 2012. Her main health problems included ineffective airway clearance, infection, pain, risk of trauma and alternation of parent-child function. Employing close observation, listening, empathy and active care, interventions were used to provide individualized care, including drawing pictures, making ornaments, listening to music and scribbling to alleviate the fear of hospital care. After explaining to her mother about the need for agastric stoma operation of by the medical team with a social worker, her mother signed the consent form and the gastric stoma surgery was carried out. After the operation, the child’s nutrition intake was improved and pulling of the N-G tube was avoided. The nutritional status and related health problems were resolved, and the child was comfortably discharged to the nursing home. By sharing the nursing process of caring for a child with Pierre Robin’s syndrome, we hope to provide nursing staff caring for children with Pierre Robin’s syndrome in the future with an example.