運用羅氏適應模式於一位胸椎脊髓病變患者之護理經驗

Nursing Experience in a Patient with Thoracic Myelopathy by Roy Adaptation Model

本文是探討一位41歲已婚婦女，因第九至第十二胸椎脊髓退化疾病，引起下半身麻痺，於住院期間的護理過程。依照羅氏適應模式的生理功能、自我概念、角色功能、相互依賴之概念架構，經由觀察、會談、身體評估等方式收集資料，確立個案住院期間主要護理問題為：(1)肢體活動障礙；(2)排便形態改變：便秘；(3)高危險性感染：長期導尿管留置；(4)皮膚完整性受損；(5)無力感。針對影響個案適應程度的行為與因素，運用護理措施的執行，予以處理其主要、相關及剩餘刺激，使個案在面對生理及心理的雙重打擊下，能增加對疾病的認知而重建自信心。並協助家屬參與照顧計劃，與個案共同面對疾病的壓力，並協助他們尋求社會資源，因而使個案能接受疾病的事實，主動且積極地運用剩餘的肢體能力來適應新的生活。茲將此一護理經驗提供同仁分享。This article probed into a 41-year married woman who was paraplegia, caused by T9-11 Thoracic Myelopathy during her nursing process in the hospital. According to the concept structure of Roy's Adaptation Model on physiological function, ego concept, role function and interdependent relationship, through the observation, face-to-face interview and physical assessment to collect data, the main nursing problems were (1) Moving inconveniently, (2) change of drain way: constipation, (3) High dangerous infection: long-term Foley stay, (4) Impaired skin, (5) Powerlessness. Aiming at the affection on the behavior and factor of patient's adaptation and using the execution of nursing procedure to give her the main, relative and redundant stimulation, the researcher let the patient increase her cognitive of disease to rebuild her confidence under the mental and physical double strikes. We also assisted her family toparticipate in this care plan to face the pressure of disease together. Besides, We helped them search social resources and push the patient to accept the fact of her disease and adapt the new life actively and positively. Therefore, the researcher bring up this nursing experience to be shared with you.