照護一位心臟移植手術後病人之護理經驗

The Nursing Experience of Taking Care of a Patient after Heart Transp1antation

本文主要探討一位心臟移植手術後病人之護理經驗。病人因接受心臟移植手術可能會面臨生理、心理、社會因應、等待死亡經歷、和經濟壓力上等問題。筆者自2009年12 月8 日至2009年12 月18 日之照護過程中，透過主動關懷來建立相互信賴的治療性人際關係、，經由收集病史、會談及傾聽等方式收集資料，以Gordon十一項健康功能型態做整體性評估，確立個案有疼痛、活動無耐力、潛在危險性成染及家庭運作過程改變等護理問題。護理過程中，以疼痛評估，提供合宜的緩解疼痛照護計劃，降低其疼痛不過；在活動無耐力方面，採漸進式下床及訓練肌肉耐受力，以使病人恢復日常生活能力；於潛在危險性成染方面，主動提供相關心臟移植術後自我照顧的技能，亦透過會談得知個案因經濟負擔所困擾，協助安排社會服務人員提供適宜社會資源，針對個案給予個別性的護理措施，以達到持續性與整體性的照護。冀望藉此護理經驗分享，能提供臨床醫護人員照顧此類病人時，除減輕術後身體不適外，也能運用同理心深入了解心理層面，協助個案能以健康的態度，面對未來的生活。This article mainly focuses on the nursing experience of taking care of a patient after heart transplantation. The patient encountered problems, such as physiology, psychiatry, social compliance, experience of waiting dying, and economic pressure. The author collected patient's data through history taking, conversation, listening and therapeutic relationship building by an active caring attitude from December 8th, 2009 to December 18th, 2009. The author also evaluated the patient as a whole through Gordon 11 Function Health Patterns to make sure the nursing problems, such as pain, activity intolerance, potential infection risk, and family's operation process. Through the nursing care three times per day, the nurse evaluated the pain scale and provided an adequate caring plan to relieve pain in order to reduce the discomfort caused by pain. As for the intolerance, we asked the patient to adopt a rehabilitation program gradually to improve muscle tolerance and daily life activity; as for potential infection risk the we provided self-care skills after heart transplantation, understood that economic burden bothered the patient the most, facilitated the social worker to provide adequate social resources, and offered individualized nursing care in the hope of providing persistent care. The author shared the nursing experience in the hope of offering clinical experience for clinicians, helped the patient to reduce discomfort after operation, used empathy to deeply involve into the patient's psychiatry, and helped the patient to face the rest of life in an optimistic attitude.