運用羅氏理論於一位年輕產婦產後子宮切除之護理經驗

The Nursing Care Experience of a Young Woman after Postpartum Tota! Hysterectomy

本篇報告主要探討一位30歲年輕的產婦，因先生是家中獨子，公婆希望倆夫妻生育多個小孩，此次產後子宮收縮不全導致大出血，子宮在個案處於未知的狀況而行全切除，因為術後造成個案身心承受巨大的創傷及身體結構改變的急性護理經驗。筆者從2007年10月31日至2007年11月7日於加護病房照護期間，運用會談、觀察及評估等方式收集相關料，同時利用個案轉至普通病房治療期間，經個案同意下訪視及出院後電話訪談，結果顯示個案有「急性疼痛」、「焦慮」、「身體心像紊亂」等三項主要健康問題，運用羅氏適應理論為臨床護理架構，與個案建立良好關係，提供減輕疼痛方法、協助釐清術後的擔心、協助面對子宮全切除的事實等措施。最後個案從術後疼痛、焦慮及無法接受產後子宮被切除的事實，到個案疼痛減輕、確定及降低心中焦慮，最後能面對子宮切除事實，著實改善個案相關健康問題。筆者將此護理經驗提出分享，期望提供臨床護理人員照護相似個案之參考。This case report concerned mainly the nursing care experience of a young woman, who was thirty years old. The husband of this case was an only son and the mother-in-law hoped them to get many children. The failure of uterus to contract after delivery occurred with the heavy uterine bleeding; therefore the entire uterus of hers was removed in unknown situations. The case did not feel deeply hurt in body and mind, but the case also had to face her physical injury. In the case report, the interviews, observations, and assessments to collect data were used during the intensive care unit (ICU) from October 31, 2007 to November 7, 2007. In addition, visiting the case with the agreement during the time when the case had been transferred to the general ward. Telephone interviews were used after the case discharge. The three primary health problems of the case report included postoperative acute pain, anxiety, and body image disturbance. The Roy-Adaptation Model was applied to the structure of clinical intervention on the development of good relations, providing pain-relieving methods, clarifying anxiety sources, and helping the case to face the uterus removed. Finally, the case would successfully decrease postoperative pain, certainly decrease anxiety, and accept the uterus removed after the interventions. The experience would provide as a reference to nursing staffs for caring the similar patients.