照護一位拒絕右手腕下截肢個案之護理經驗

The Nursing Experience of Caring for a Patient With Refuses Amputation Below the Right Wrist

個體常因疾病或身體外觀和功能的改變，無法認清事實作適當的調適，造成身心傷害及壓力，甚至對未來生活產生無望感。本文所描述的是一位糖尿病右手傷口感染，且正值中年期，身負養家重擔的個案，遲遲無法接受右手腕下截肢手術，出現否認、憤怒、身體心像改變及無望感之負向行為反應。筆者於2007年9月29日至10月11日個案住院期間，以會談、護理、觀察及傾聽技巧收集資料，利用Gordon十一項健康功能型態評估個案，確立個案的護理問題包括：疼痛、身體心像紊亂及無望感。在護理過程中運用主動關懷，傾聽，與個案建立信任感，提供相關醫療資訊，協助維持自我照顧，運用希望來幫助個案面對內心真實感受，增加自我控制感，以重建正向之自我概念。希望藉此護理經驗能提供臨床照護之參考。Patients with diseases or changes of the body appearance or function always can't recognize the fact and adjust themselves properly. This may impair the patients' body and mind and cause a lot of pressure, even produce the sense of hopelessness to the future. This report describes a case of a diabetic patient, a middle-aged male carrying the responsibility to look after his family, with right hand wound infection. Under the circumstances, he couldn't accept amputation of his right wrist, and he developed some behaviors such as denial, anger, body image change and hopelessness. During the caring period (September 29 to October 11, 2007) the author collected information by conversations, nursing care, observation and listening skill, and the Gordon 11-items functional health assessment was applied to assess this case. The nursing problems of the case include: pain, body image disturbance, and hopelessness. During the nursing care process, the author listened to the patient's concerns and feelings actively, and established a good nurse-patient relationship. The author also provided the subject medical treatment information and assisted him with self-care procedures, trying to help the subject establish hope, to enhance his self-control, and to re-build his positive self-concept. This nursing experience can provide references for further clinical nursing care.