一位週邊動脈阻塞疾病患者接受截肢的調適過程及行為反應

The Adaptation Process and Behavioral Responses of a Patient with Peripheral Arterial Occlusive Disease Who Has Undergone Amputation

本篇研究目的在探討一位85歲婦人，因周邊動脈阻塞疾病，導致下肢壞疽而截肢的調適過程及其行為反應。本文採田野研究方式，在實際護理過程中運用觀察及會談等技巧收集個案的行為反應，將所收集到的資料寫成行為過程記錄，並使用行為分期模式作為依據加以分析整理，結果顯示其行為反應可歸類成三個階段：第一階段衝突期：因強烈拒絕截肢對身體心像的破壞而出現否認、焦慮、磋商等情緒；第二階段退卻期：術後得面臨肢體的喪失及身體不適，又得配合一連串的醫療處置與復健計畫，而呈現沈默、退縮、無望等行為反應；第三階段接受／重建期。逐漸接受截肢的事實而開始復健活動。在護理過程中協助個案緩解截肢前後的情緒反應，幫助個案發展面對截肢的失落知覺，並積極安排具體、個別性的復健計畫，使其順利地因應截肢所帶來的衝擊。希望藉此結果能提供臨床照護的參考。

The purpose of this study was to explore the adaptation and behavioral responses of an 8syear-old woman who suffered from gangrene related to peripheral arterial occlusive disease and finally underwent lower limb amputation. The field method was adopted. Records of the patient's behaviors were collected by observation and interviews. The data were recorded by nursing process recording and analyzed using the Behavior Classification Model. The findings showed the patient's behavioral responses to be categorized by three phases. The first phase was the impact phase: patient objected to amputation strongly because it would destroy her body image. She experienced moods of anxiety and denial moods etc. The second phase was the regressive phase: after the amputation, the patient experienced a sense of loss and discomfort while having to cooperate with medical treatment and rehabilitation. Silence, withdrawal, and despair were some of her reactions. The third phase was the acceptance reconstruction phase: the patient accepted the fact of her amputation with time and started her rehabilitation. During the process of providingnursing care, we helped the patient to vent her emotional responses, helped her to develop awareness of her ability to face the loss of her limb, and aggressively planned individualized rehabilitation for her. Finally, these interventions enabled the patient to overcome the impact of her amputation. The findings of this study should provide references for further clinical nursing care.