應用紐曼模式於一位慢性阻塞性肺疾病患者之護理經驗

A Nursing Experience for Application of the Neuman System Model to a Patient with Chronic Obstructive Pulmonary Disease

本文是一位84歲慢性阻塞性肺疾病患者的護理經驗。護理期間為2009年1月7日至2009年01月10日，利用會談、觀察、評估及身體檢查等方式收集資料，並以紐曼系統之生理、心理、社會文化、發展及靈性等層面分析其壓力源，個案主要壓力源為個人內在之生、心理層面，因呼吸道症狀惡化，而引起心理情緒低落，並發現主要健康問題有：低效性呼吸型態、體液容積過量、活動無耐力及害怕，針對其護理問題與病人共同擬定計劃，提供漸進性肺部復健運動及個別性護理措施，積極處理個案生心理壓力源，以鞏固內在抵抗線及穩定正常防禦線，使個案達到安適狀態。本個案報告之護理經驗提供慢性阻寒性肺疾病患者急性惡化面臨生命威脅之處置與長期罹病之希望重建，藉以提供臨床人員照顧此類個案之參考。

In this study, the Neuman System model was applied while caring for an 84-year-old patient with chronic obstructive pulmonary disease. The period of nursing care was from January 7 to January 10, 2009. Data were collected by means of interview, observation, assessment, and physical examination. With the Neuman System model, the data were analyzed in terms of the stressors in physiological, psychological, social and cultural, and developmental and spiritual aspects. The patient’s main stress came from physiological and psychological problems. The patient was emotionally depressed secondary to acute exacerbation of the respiratory disease. Identified major health problems were ineffective breathing pattern, fluid overload, activity intolerance, and fear. Individualized nursing interventions included progressive pulmonary exercises for rehabilitation and proactive stress management, which helped strengthen the patient’s disease resistance and defense mechanisms. This article serves as a reference for clinical nurses who care for COPD patients with acute exacerbation facing a life threatening situation.