運用Orem理論協助一位人工髖關節脫位病患的護理經驗

Application of Orem’s Theory to Nursing Care for a Patient with Dislocation of Total Hip Relocation

本文運用Orem自我照顧理論，協助一位74歲女性個案，因術後臥床不動及跌倒造成再次脫位而產生壓瘡及身體活動功能障礙之護理經驗。照護期間自民國95年10年31日至11月13日，出院後以電訪追蹤居家照顧情形，筆者依據Orem之自我照顧需求理論，評估個案自我照顧需求及能力，確立其護理問題為自我照顧能力缺失（沐浴及如廁）、身體活動功能障礙、皮膚完整性受損。護理照護期間，針對因意外進行人工髖關節置換術俊個案所產生身心健康問題及居家俊續照護問題，瞭解其照護需求，共同訂定有效之護理計劃及居家復健措施，提供激勵、支持等整體性照護，以加強了個案之自信心、復健動動及自我照顧意願，並提昇個案個人衛生、洗澡等自我照顧能力。由此次照護經驗中，不僅是個案恢復自我照顧能力，更減輕照顧者生心理之負擔，藉此經驗能做為護理同仁照護人工髖關節脫位個案參考。

With the application of Orem's nursing theory, the nursing interventions were designed for a 74-year-old female patient with dislocation of total hip relocation. Due to long term bed rest after a surgery and dislocation of the hip joint relocation secondary to fall, the patient developed pressure ulcers and functional disability. Based on Orem's Theory, which emphasizes self-determination, the patient was diagnosed as lacking the ability of self care such as bathing and toileting, physical and functional disability, and impaired skin integrity. After the second surgery for the relocation of the total hip dislocation, the patient further exhibited issues in psychological and home care. The author provided patient care during the patient's hospital stay and followed up the patient via telephone calls from October 31 to November 13, 2006. To enhance the patient’s self- confidence, self-motivation, and self-volition, the designation of an effective nursing care plan, which included self care activities such as personal hygiene and rehabilitative measures at home, was developed. This care model not only built up the patient's ability of self care, but also relieved the care burden on the patient's family and significant others.