運用關懷照護概念協助一位門診手術兒童及其母親之護理經驗

An Experience Nursing an Ambulatory Pediatric Surgery Patient and His Mother: The Practice of Caring

本文是運用關懷照護的概念協助一位7歲學齡期兒童及其母親於門診手術時在局部麻醉下接受血管瘤切除手術之護理經驗。在護理過程中運用關懷照護的精神與個案及案母建立良好的人際互動，運用學齡期兒童發展特質及重視同儕之特性，給予口語化的說明引導，強調其勇敢之表現，增加其克服害怕及疼痛之信心。因適時給予情緒的表達及支持，使個案於手術期間身體和心理能達到舒緩，圓滿完成手術並於返家後來函感謝。而案母也能在護理過程中了解手術的相關資訊，減緩因為子女手術所帶來的壓力，進而能協助安撫個案害怕的情緒。學齡期兒童臨床上施行手術以全身麻醉為主，但本個案之護理經驗證明只要給予合宜的護理措施仍可在局部麻醉下實施手術，避免全身麻醉所導致學齡兒童潛在的危險。

A seven-year old child was scheduled for excision of hemangioma under local anesthesia. Utilizing the concept of caring, we provided pre- and intra-operative support to both the patient and his mother. Before the operation, we effectively established the self-confidence of the patient by providing sufficient disease-related information and encouragement in a child-oriented approach, in order to enable the patient to overcome fear and pain. This caring approach proved effective during the operation since the patient was fully aware of each surgical step and the levels of pain to be experienced. The mother was also involved throughout the process. She was therefore not only emotionally pacified, but also actively involved in the psychosocial support process. Traditionally, almost all surgical procedures in pediatric patients have been performed under general anesthesia. This report indicates that under appropriate care some of the less invasive surgical procedures in school-age children can be carried out under local anesthesia to avoid the risks involved in general anesthesia.