一位接受心臟移植手術患者面臨健康尋求行為之護理經驗

Nursing Experiences of a Heart Transplant Patient Faced with Health Promoting Activities

本篇個案報告是護理一位因罹患擴張性心肌症接受心臟移植手術的患者，其面臨手術治療後之健康尋求行為。筆者藉由觀察、會談、身體評估、病歷資料、檢查報告及與其他醫療人員討論，並根據戈登(Gordon)功能性健康型態評估，發現個案及家屬非常積極詢問有關一切生活細節的照護及注意事項，對於健康的尋求行為強烈。經由主客觀資料，協助個案瞭解疾病治療過程、胸前傷口與術後侵入性引流管照顧、藥物的重要性、正向面對焦慮產生的情緒及返家之居家照顧，並且讓個案與家庭有良性互動，以尋求健康行為之維護。筆者於護理過程中，運用護理指導、傾聽、陪伴、引導其說出心中感受及情緒之抒發、並配合醫師給予說明心臟移植手術的合併症、且提供相關心臟移植術後居家照顧的健康訊息，以達到持續性與整體性的照護。護理人員在病患住院期間應主動提供相關訊息，以因應病患生理、心理及社會等層面的改變，期盼本文可做為臨床醫護人員面對心臟移植病患的護理指引。

This article described the health promoting behaviors of a dilated cardiomyopathy patient after receiving heart transplant surgery. Through observations, conversations, body evaluations, medical history information, examination reports, discussions with other medical staff, and using Gordon’s functional health assessment, the author discovered the patient’s rigorous health promoting behaviors, as well as active inquiry about nursing precautions and concerns by his family members. The patient was provided with both subjective and objective information so that he could understand the therapeutic process of the disease, including the care for chest wounds with post-surgery invasive drainage tubes, the importance of medications, the value of a positive attitude toward anxiety, and caring procedures at home. The patient was encouraged to have positive interactions with the family to promote the continuation of healthy behaviors. The author utilized nursing instructions, listening skills, and companionship to guide the patient to express himself emotionally. The author also worked with the physician to explain the complications of the heart transplant surgery to the patient and to provide health related information about the continuous and comprehensive care of the patient at home. Nursing staff are encouraged to actively provide necessary information to the patient during the hospitalization period to facilitate management of the physiologically, psychologically, and socially related changes of the patient. The article can serve as a reference for caring heart transplant patients in the future.