以Orem理論照護一位因急性脊髓炎導致癱瘓個案之護理經驗

Nursing Experience While Applying Orem Theory to a Paralysis Patient with Acute Myelitis

急性脊髓炎係因病變侵犯脊髓橫斷面幾個節段，故常稱為急性橫貫性脊髓炎。臨床特點為肢體癱瘓、各種感覺缺失、以及膀胱、直腸、植物神經功能障礙，因此在照護上需要預防褥瘡、肺部、泌尿系統感染等等合併症的發生。本篇報告探討一位急性脊髓炎患者，在由步行入院到下半身癱瘓的罹病過程中，所帶給個案及家屬莫大衝擊的身、心及社會問題。筆者於2007年12月10日至12月20日護理期間，藉由觀察、評估、與家屬會談及病歷紀錄來收集資料，並運用Orem自我照顧理論進行護理評估後，確立個案有疼痛、呼吸道清除功能失效、皮膚完整性受損及無望感等四項最迫切需要優先解決的護理問題。經提供適當之護理措施，來協助個案克服疾病所帶來的生理症狀，並避免合併症的發生；鼓勵個案及家屬參與自我照顧訓練及復建計畫，使個案能以正向的態度面對疾病的衝擊；並適時提供關懷，增進其非語言溝通的能力減低個案之無望感，進而達到改善生活品質的目標。

Acute myelitis is also called acute traverse myelitis because of the pathological changes. The clinical characteristics are paralysis of the limbs, a lack of feeling, and neural functional disorders of the bladder, rectum and plant. This article describes a nurse's experience caring for an acute myelitis patient who was suffering from low extremity paralysis. The greatest impact of the disease on the patient and the patient's family were in terms of physical, psychological and social problems. Orem's theory was utilized in this study to evaluate the patient. Observation, assessment and interviews with family were conducted from December 10(superscript th) to December 20(superscript th), 2007. After evaluation, it was determined that the problems facing the patient included pain, ineffective airway clearance, impairment of skin integrity and hopelessness. Through the adequate nursing intervention, it was possible to improve the physiological symptoms, and avoid complications. This encouraged the patient and the patient's family to develop selfcare of the patient, which improved the patient's attitude and had a positive impact on the disease. Specifically, promoting non-verbal communication, and then reach for goals that improved the patient's quality of the life were particularly useful.