運用紐曼模式於一位頸椎損傷病患之護理經驗

The Care Experience of a Cervical Vertebra Injury Patient on Neuman’s Model

突如其來的受傷對頸椎損傷患者是一個莫大的衝擊，除必須面對生理下半身癱瘓的不適，受傷部位感覺喪失、肢體不聽使喚、大小便無法控制，連自身的基本能力都無法自主，其人生所遭受的挑戰極大，除了須面對急性期所帶來的身體不適，更需面對日後復健及家庭調適壓力。本文敘述一位頸椎損傷病患，在加護單位所面臨急性照護問題及心理狀態，藉由Neuman理論壓力源評估發現，個案主要面臨三個護理問題，包括(1)無效性呼吸；(2)心理調適障礙；(3)家庭因應失調等問題。照護期間，筆者與個案及案夫建立良好關係，協助個案急性期呼吸道照護，並確認個案心理及家庭因應問題，詳加說明病情及預後陪伴個案，協助日後照顧者安排，讓個案能提高生活品質，以達到個案全人照護。

Unexpected injuries of cervical spine make a tremendous impact on physical and psychological changes. Patients with cervical spine injury are faced with discomfort of paraplegia such as sensory impairment and movement disorder in affected limbs, and fecal and urinary incontinence. Limited physical autonomy is a formidable challenge to patients. Besides the discomfort in acute stage, patients must also deal with the stress of future rehabilitation and family adaptability. This paper detailed a nursing experience in the acute nursing problems and psychological state of a cervical spine injury patient in an intensive care unit. Using Neuman Systems Model, the assessment was carried out to identify possible stressors and established three major nursing problems, including (1) wasted ventilation; (2) psychological adjustment barriers; (3) ineffective family coping. During the nursing period, the author created a good relationship with the patient and her spouse and assisted them not only in respiratory caring in acute stage and caregiver arrangement in the future, but also by confirming psychological and family coping problems, elaborating patient’s condition and prognosis, and providing companionship, which can effectively enhance the patient’s quality of life and achieve sustained holistic care.