運用Mishel不確定感理論照顧一位膝下截肢患者之護理經驗

Applying Mishel’s Uncertainty Theory to Care a Patient with Lower Extremity Amputation

截肢後，病患在身體、心理及社會層面上遭遇到很大的衝擊，同時也需要面對未來不可預知的挑戰，容易產生不確定感。本文的目的是描述照顧一位膝下截肢病患出現不確定感之護理經驗。照顧期間，筆者深入了解病患的感受，並運用Mishel不確定感理論，評估到個案對日後生活功能的恢復有不可預測感，對義肢的相關訊息感到模糊與缺乏，以及不確定是否能維持家庭功能正常運作。因此確立個案有不確定感之護理問題。在護理過程中運用教導自我照顧技巧、提供復健及義肢相關資訊、介紹成功個案、鼓勵家人雙向溝通及參與照顧活動、給予正向支持及訂立合理的期望等措施，以減輕其焦慮及不確定感，進而協助病患早日達到適應狀態。

Amputation causes physical, psychological, and social disturbances of an amputee’s life. At the same time, amputees need to face unpredictable challenges in the future; therefore, uncertainty is easy to be produced. The purpose of this article was to describe the nursing experience of helping a lower extremity amputee with the feeling of uncertainty. By understanding feelings of the patient and applying the Mishel’s Uncertainty Theory during the nursing period, the authors found that the patient thought the recovery of functional level of daily activities was unpredictable, the information about rehabilitation and prosthesis was vague and deficient, and the maintenance of normal family function was indefinite. The nursing problem of uncertainty was established. During the nursing period, we taught self-care skills, provided information about rehabilitation and prosthesis, introduced the successful case, encouraged two-way communication between family members and participated care activities, set reasonable expectations, and offered positive support to the patient. These strategies helped the patient reduce the feelings of anxiety and uncertainty and achieve the adaptive status as soon as possible.