運用護理指導技巧增進一位壞死性筋膜炎患者傷口照護能力之護理經驗

Application of Nursing Guidance to the Incision Care of a Patient Post Fasciotomy

本文係描述筋膜切開手術後之加護護理經驗。文中男性病患因壞死性筋膜炎而接受筋膜切開術，筆者運用情意、認知、技能之護理指導技巧來增進患者術後傷口照護，護理期間自2010/9/15至2010/9/20，以Gordon十一項護理評估為指引，藉由直接護理、觀察、會談傾聽以及病程紀錄等方式來收集資料，發現個案有急性疼痛、組織完整性受損及知識缺失之護理問題。經由主動關懷、展露同理心及耐心傾聽建立良好護病關係，護理過程中除提供緩解疼痛及控制感染措施外，並詳盡說明護理指導單張，實際操作示教傷口護理，增進個案對傷口照護的認知及技能，而能正視傷口及參與傷口照護，最終恢復到預期健康狀況。期望藉此經驗之分享，提供護理同仁照護病患之參酌。

This article describes the nursing experience of incision caring for a patient who had surgery for fasciotomy due to necrotic fasciitis. The author took care of the patient's incision with nursing guidance during the nursing period from September 15 to 20, 2010. Using Gordon's eleven functional health patterns as an assessment tool, the author collected data through direct nursing care, observation, interview, active listening, and medical record analysis. The patient's identified problems were suffering from acute pain, impaired tissue integrity, and lack of knowledge. A good nurse-patient relationship was established through proactive caring and listening with empathy. The nursing interventions included not only relieving the patient's pain and controlling the incision's infection but also developing a patient education sheet and demonstrating wound care to enhance the patient's awareness of and participation in wound care with the expectation of a healthy recovery. The author hopes that this experience can serve as a reference for other nurses taking care of similar patients.