運用Levine保存模式照護一位敗血症個案之護理經驗

A Nursing Case Experience Using Levine's Conservation Model to Provide Sepsis Care

敗血症是因感染而引起的全身性發炎反應，病程進展快速，影響全身器官功能，進而造成個體生命威脅。目前以實證基礎之敗血症組合照護（sepsis bundles），配合強調整體性評估及全人照護之護理模式，應可改善敗血症病人照護成效。筆者利用Levine保存模式照護一位敗血症個案，照護期間自2011年6月10日至2011年7月5日，透過身體評估、病歷查閱、病人筆談、家屬及訪客會談與觀察方式收集相關資料，並根據保存模式進行護理評估，發現個案無法成功調適其能量、結構、個人完整及社會完整性等四個保存原則。護理過程中，藉由提供敗血症組合照護模式及初步復甦措施，協助個案獲得能量的保存；以感染的預防，維持其結構的完整；維護自尊、隱私與維持家庭及社會活動，保存其個人及社會功能的完整，最後成功調適因敗血症造成的整體性失衡。期望此保存模式運用的照護經驗分享，可提供護理人員日後於臨床照護敗血症個案之參考。

Sepsis is a systemic inflammation caused by severe infection. It is a condition that is life-threatening, progresses rapidly, and affects multiple system functions. An evidence-based medical sepsis bundles model has been used for sepsis care in clinic practice. Therefore, a holistic nursing care protocol for patients with sepsis is needed to improve medical outcomes. This case study describes a nursing experience using Levine's Conservation Model to care for a patient with sepsis. Data were collected using physical assessment, medical chart reviews, written communications with the patient, interviews patient family members, and observing the patient during intensive care hospitalization from June 10th, 2011 through July 5th, 2011. Levin's Conservation Model, used as the nursing guideline, successfully identified patient issues including failure to conserve energy, structural, personal and social integrity. Interventions included: (1) sepsis bundles and early goal directed therapy to reduce patient energy expenditure; (2) prevention of infection to maintain structural function; and (3) enhancement of self-esteem, privacy, family cohesion, and social activities to maintaining personal and social integrity functions. The interventions helped the case adapt successfully to the sepsis-related imbalance. This case report provides a valuable nursing care experience as a reference for similar sepsis cases in the future.