一位因小腿損傷有自殺意念青少年病患的護理經驗

Nursing Experience of Caring a Teenager with Lower Leg Injury and Suicide Idea

本報告是描述一位19歲青少年，面對車禍後左小腿功能及外觀改變而萌生自殺意念的護理過程。筆者於90年4月20日至90年6月9日以直接護理、觀察及會談法收集資料，並運用Roy's適應理論模式評估，分析個案有疼痛、現存性感染、無望感及身體心像改變等健康問題，乃採持續性的關懷、傾聽並以同理心鼓勵個案說出心中的感受，以減輕疼痛及感染控制護理措施的介入，使其疼痛獲得緩解且傷口無感染徵象，並能主動說出對疾病預後的惶恐與不安、接受身體心像的改變、解除其自殺的意念。出院後筆者持續以電話關心了解個案復原情形，增進其回歸家庭及社會的適應力，90年12月1日回到原來的工作崗位。由此護理經驗深感繁忙的臨床工作常使得護理人員無暇顧及個案創傷後負向心理反應所造成的影響，故惟有細心適切的重視個體，深入了解個別性之心理問題並即時協助解決，方能提昇及展現護理品質的專業性與獨特性。

The purpose of this study was to address the nursing process of caring a teenager with lower leg injury and suicide idea after a car accident who experienced functional change in lower leg and change in body image. The data were collected through observation and consultation during primary nursing period from the 20th of April to the 9th of June in 2001. Nursing care and evaluation model based on Roy's adaptation theory was used. Health problems of the case included pain, existing of infection, hopelessness, and body image change. The major interventions included continuous caring, listening, sympathy, pain relieving, and infection control. After the pain was well controlled, the patient was able to express his existing condition sufficiently. Finally, the changed body image was accepted and the patient was convinced away from the idea of suicide. The condition of recovery and adaptation were followed through telephone after the patient was discharged. The patient was able to return to work on the 1st of December in 2001. In summary, professional and individual nursing care was crucial to the patient experiencing negative psychological reaction after trauma. How to balance between quality clinical nursing care and the routine work loading is an art to the uniqueness of professional nursing.