運用羅氏適應模式照護一位術後 之尿道下裂幼兒及其照顧者

Applying the Roy’s Adaptation Model to Care a Post-surgery Child with Hypospadias and His Caregiver

本文運用羅氏適應模式照護一位患有尿道下裂幼童術後的護理經驗。照護期間自2014年3 月14日至2014年3月20日，以羅氏適應模式為評估指引，經由直接照護、身體評估、觀察及會談等方式收集資料，確立個案的主要健康問題有：急性疼痛、潛在危險性感染、照顧者角色緊 張。以患者及家庭為中心之理念，依據個案的發展及疾病特性，協助照護者進行合併止痛藥物及 非藥物方式降低個案因治療及陌生環境引起的不安及不適，使嬰幼兒術後疼痛量表（children's and infants' postoperative pain score, CHIPPS）指數降低；製作衛教單張，提供家屬易於明瞭照護原因、 目的及方式，與家屬建立夥伴關係，一同執行及商討適合個案之可降低術後感染的照護，以達到傷口癒合期間無感染之目標；藉由提供照護及教導相關資訊，進而建立信任感，並以支持、陪伴及傾聽協助主要照護者，促使達成適應與健康狀態照護目標。希冀此照護經驗能提供兒科同仁照 護之參考。

The purpose of this article described the nursing experiences of applying the Roy's Adaptation Model to care a child with post-surgery of hypospadias. The caring period of time was from March 14th to March 20th 2014. This model was used as an assessment guide for nursing care, physical examinations, observations and interviews to assemble information. The identified primary health problems were: acute pain, potential risk for infection and caregiver role strain. Patient-and family-centered care was based. According to the development of patient and character of disease, work together with caregiver in order to decrease child's pressure and declining CHIPPS. At last, achieve their well-being. A pamphlet concerning about notices of hypospadias post-surgery was given to caregiver to understand the disease and how to care. It also helped develop trust and companionship among patients and caregivers. We also assist caregiver to identify the controllable or uncontrollable stress, and achieve the health status psychologically and physically. The experiences could provide as a reference for pediatric staff.