照護一位初次診斷肺結核病患之護理經驗

A Nursing Experience of a Patient with Preliminary Pulmonary Tuberculosis

本文主要探討一位初次診斷肺結核病息之護理經驗。個案因疾病而面臨隔離的措施，導致心理上的害怕，及缺乏肺結核疾病的知識而承受極大的壓力。照護個案期間自2008年3月19日至2008年4月10日，筆者經由直接照顧、紀錄、觀察及深度訪談方式收集資料，以Gordon十一項健康功能型態為評估架構，分析並歸納出個案護理健康問題為：體溫過高、特定知識缺失、而嚴格的隔離措施也引發出焦慮及社交隔離的健康問題。筆者建立相互信賴的治療關係，以傾聽、有效的溝通，鼓勵個案表達其感受，並予以心理支持減輕焦慮；以個別性的護理措施，使個案於發燒期間獲得舒適與安全感；此外，運用有系統的護理指導，提供完整的衛教知識解決個案的特定知識缺失問題；並且增加其社交活動，進而改善社交隔離問題。肺結核的照護不僅是著重於疾病的衛教或解決生理上的問題，更需要心理情緒之照護，協助個案健康的態度，面對未來的生活。

This article explores the nursing experience of a patient with preliminary diagnosis of pulmonary tuberculosis (TB). The patient was stressed with fear of isolation and lack of knowledge about the disease. The period of nursing care lasted from March 19 to April 10, 2008. The author collected data by means of direct care, nursing documentation, observation, and detailed interview. Gordon's 11 functional health patterns were used as the framework for patient assessment. With data analysis, identified nursing problems were fever, lack of knowledge about disease, and anxiety secondary to social isolation. Through active care, the author and the patient established a therapeutic relationship with mutual trust. With active listening and effective communication, the author encouraged the patient to express his own feelings. The patient's anxiety was reduced with the nurse's support. Individualized comfort measures were provided for the patient's fever and safety. Under the nurse's systemic guidance, the patient understood the disease process and self care. The patient was more proactive in participating in social activities, which improved the issue of isolation. Through the effective referral system, the patient could receive continuous care and follow up after discharge from the hospital. Nursing care of the patient with TB not only focuses on the issues of physical symptoms and patient education, but also emphasizes individualized psychological needs for the purpose of fostering a healthy attitude toward future life.