運用羅氏適應模式於一位重症肌無力症學齡兒童之加護護理經驗

Nursing Experience of a School-Age Child with Myasthenia Gravis by Applying Roy’s Adaptation Model in PICU

本文係運用羅氏適應模式探討一位學齡期重症肌無力病童發病後入住加護病房期間之護理經驗。依羅氏適應模式之概念架構進行評估，藉由參與性觀察、會談、身體評估等方式收集資料，確立個案主要護理問題為：一、低效性呼吸型態，與痰液黏稠、肌無力及綠膿桿菌肺部感染有關。二、活動無耐力，與全身肌肉無力及長期臥床休息導致活動減少有關。三、分離焦慮，與住進兒科加護病房陌生環境及與案父母分離有關。四、言辭溝通障礙，與肌肉無力、口齒不清與氣切管放置有關。針對影響個案適應程度的行為與因素，提供維持呼吸道通暢的照護、彈性會客與治療性遊戲、依據耐受力安排活動型態、溝通輔助工具等護理措施，來處理其主要、相關及剩餘刺激，使個案在加護病房期間維持呼吸道通暢，減低分離焦慮，增進自我照顧能力及建立適當溝通模式與信任關係。正如羅氏適應模式提及人是一個適應系統，個案需同時面對多重改變，因此護理人員必須用心傾聽與體會個案的真實感受，設身處地評估與解決護理問題，才能協助個案達到最佳適應，讓身心創傷減到最低，有效提昇兒童及家屬的生活品質。

This article reported the nursing experience of applying Roy’s adaptation model (RAM) to assist a school-age child with myasthenia gravis in PICU. According to the conceptual framework of RAM, data were collected through participant observation, interviews, and physical assessment. The main nursing problems were: 1. Ineffective breathing pattern, which was associated with adhesive sputum, myasthenia and Pseudomonas aeruginosa infection; 2. Activity intolerance, which was associated with myasthenia gravis and long-term bed-rest resulting in decreasing activity; 3. Separation anxiety, relating to hospitalization in PICU and separation with parents; and 4. Impaired verbal communication, resulting from myasthenia, slurring speech, and tracheotomy. Nursing intervention included airway patency intensive care, liberal visit schedule, therapeutic play, and arrangement of activity pattern according to tolerance, and use of communication-assisted tools. These interventions could assist the case to maintain airway patency in PICU, lessen separation anxiety, promote self-care ability, and establish proper communication model and trust relationship. As RAM stated, each single person is an adaptation system. The case faced multiple changes at once. Pediatric nurses are encouraged to listen and realize patient’s real feeling and put themselves in patient’s position to assess and resolve problems. With optimal adaptation and minimized physical and psychological trauma, the quality of life of the family and the children can be effectively promoted.