運用超連結系統理論協助一位第六胸髓損傷患者重返校園之護理經驗

A Nurse’s Experience Using the Super-Link System Theory to Help a T6 Spinal Cord Injury Patient Return to School

本文是探討一位20歲女性，因車禍導致第六胸髓損傷合併下肢癱瘓，在住院期間學習如何處理自主神經反射障礙誘因、接受間歇性自我導尿訓練及強化社會資源連結以達到重返校園之護理經驗。自2008年11月20日至12月30日的照護期間，經由會談、觀察及身體評估的方式收集資料，確立個案有自主神經反射障礙及增進重返校園的準備度等護理問題。在護理期間運用超連結系統理論執行個別性的護理過程，讓個案瞭解自主神經反射障礙常見原因，學習處理誘因，於日常生活中預防可能產生之不適症狀，以防再次發生；協助個案執行自我導尿法，使餘尿定時排空，預防泌尿系統病變，並給予持續性關懷並強化個案支持系統，轉介成功個案和相關社會資源，協助執行復健活動，增加身體的控制感，以漸進式方式重建自我照顧能力，協助個案適應新的生活型態，藉由重返校園來增進自我肯定，以及踏入職場的準備。

The subject of this article is a 20 year-old female with thoracic spinal cord injury with paraplegia suffered during a car accident. The article reports on the nursing experience in helping the patient manage her autonomic dysreflexia (AD), training the patient in self-catheterization, and using relevant social resources in order to achieve a successful return to her studies at school. The authors collected data using interviews, observations, and physical assessments between November 20 and December 30, 2008. The two nursing diagnoses of AD and inadequate preparation for a successful return to school during rehabilitation hospitalization were made during caring procedures. Holistic nursing assessment was employed and the Super-Link System Theory was applied to establish a link between the hospital and school. Individual nursing interventions used included understanding the inducement and treatment of AD, performing self-catheterization, and enhancing the support system by introducing successful clients and relevant social resources in order to transition the patient successfully to her new post-injury life. The patient consequently transitioned smoothly from rehabilitation hospital to school. The authors hope this case report will provide a useful reference for nurses charged with caring for patients with spinal cord injuries while still enrolled at school.