一位手部截肢患者之創傷後反應和調適過程之探討

The Post-Traumatic Response and Adaptation Process of a Patient with Traumatic Hand Amputation

勞工在遭遇到職業性創傷後，大都會發生心理、生理、經濟與社會等等之障礙。本文以探討一位中年男性勞工在遭遇到右手職業外傷後，經多次治療及手術後，仍需面臨截肢的護理經驗，期望能提供臨床專業人員參考，以促進臨床護理品質之提昇。本文以個案研究，立於主護護士的角度，將護理個案期間，撰寫成12篇行為過程實錄，導入「創傷後反應」之概念，分析整理歸類個案於創傷後之反應，發現個案出現了「事件衝擊性表徵」、「情緒性表徵」、「功能改變性表徵」共13項定義特徵及身體心像的改變。個案本身所採取之調適行為有「問題取向調適策略」及「情緒取向調適策略」內容包括焦慮、否認、害怕、逃避、宿命論等。筆者對個案提出的護理措施包括建立信任關係、協助尋求醫療上資源、提供靈性支持、學習替代技巧、介紹成功個案等等，成功地協助個案面對與突破其生理與社會之障礙。本文實為個案護理實例，筆者運用創傷後反應之護理照護概念、技巧與護理措施，陪伴個案成功地面對(coped with)與處理其失去的右手手指，不僅提供個案所需的整體性照顧，亦減低因非計劃性截肢對個案之身、心、家庭、社會及經濟的衝擊協助其適應，重新面對新生活。

Patients with traumatic hand injuries often encounter various physiological, psychological, emotional, and economical and social stresses after the accident. This article shared the nursing experience towards a middle age man who underwent a series of treatment along with several surgical procedures after an occupation hand injury, yet still faced the fate of right hand fingers amputation. During the nursing care, data were collected as 12-process recording. The results were analyzed based on the identified characteristics of post traumatic responses. The results showed that the patient had 13 characteristics of post traumatic responses presenting in the event impact manifestations, emotional manifestations, functional change manifestations, and body image disturbance. The coping behaviors included problem-oriented coping behaviors and emotion-oriented coping behaviors, including anxiety, denial, fear, escape, and fatalism. Nursing interventions included establishment of mutual trust relationship, assistance in looking for medical resources, support in spirituality, and learning of alternative skills. This case report could serve as a reference for caring amputation patient.