照顧一位面臨截肢壓力出現自殺企圖患者之經驗

Experience with Taking Care of a Patient that Attempted Suicide due to Pressure of Amputation

本篇個案報告是描述一位中年血液透析患者，因糖尿病足部傷口感染而必須面臨截肢之照護經驗。個案於民國74年開始罹患糖尿病，本身又有白內障而造成視覺障礙，對於足部照護顯得疏忽，進而造成足部傷口潰爛癒合差，必須面臨截肢的問題，同時間又因缺乏家庭支持系統，不但不願意配合治療，且有自殺企圖出現，在雙重身心壓力下，讓個案身體功能受損及心理飽受衝擊。個案於民國90年間罹患腎衰竭需接受常規血液透析治療，護理期間自民國98年3月3日至民國98年3月31日，筆者利用個案來院透析治療時，經由實際照護、會談及電訪等方式收集資料。以羅氏適應模式評估發現個案有營養狀況改變少於身體需要、疼痛、個人因應能力失調及家庭因應能力失調等問題，在護理過程中，主動關懷個案並與個案建立良好的互動互信關係，運用自殺防治的照護，協助個案面對疾病及接受截肢治療，並打消自殺念頭。照護過程中運用適當的護理措施減輕個案不適，肯定個案自我能力，最後更讓個案面對對往後裝義肢之計劃。藉此次護理過程希望提供個案迎接疾病所帶來的挑戰，坦然面對疾病發展，促使個案在人性化的護理過程中得到正向的心理適應。

This report is about the experience of caring for a middle-aged hemodialysis patient with diabetes who attempted suicide because an infected foot injury required amputation. The case was diagnosed with diabetes in 1985 and eye sight had been further weakened by cataracts. Negligence caused a foot injury to fester and amputation was the only option. The lack of a family support system worsened the situation with the patient not only resisting treatment but also contemplated suicide. The multiple afflictions meant the case's bodily functions and mental life were seriously compromised. The patient had sustained kidney failure and has been receiving regular hemodialysis since 2001. During the period from March 3, 2009 to March 31, 2009, we collected the information about the patient when he came to hospital for hemodialysis through direct care, interview and phone call. Use the Roy's Adaptation Model, it was found that the patient's problems include inadequate nutrition, pain, inability to adapt to change, and loss of family support etc. During the nursing process, we actively sought expressed support for the patient and attempted to establish a good relationship. Suicide prevention and treatment techniques were also used to help the patient face the disease, accept medical treatment and stop thinking about committing suicide. We mitigated the pain through proper nursing measures, affirmed his self-image and helped him come to terms with plans for a prosthesis in the future. Through this nursing process we hoped to help the patient face the challenges of the disease, accept its future progression and ultimately, promote a positive state of mind in the patient through a humanizing caring process.