照顧一位斷指重建女性患者術後面臨抉擇衝突之護理經驗

The Nursing Experience of a Female Patient Receiving Finger Reconstruction Surgery to Face a Decisional Conflict

本文個案為年輕女性，因工作造成創傷性截肢，在斷指重建術後面臨婚姻和個人健康間抉擇衝突，引起筆者想深入探討。本文護理期間為2012年12月05日至12月12日，應用Gordon 十一項健康功能評估為架構，藉由直接照護，運用觀察、會談、身體評估等方法進行資料收集，確立個案主要健康問題：急性疼痛、潛在危險性感染、焦慮及抉擇衝突。筆者在照護期間，透過換藥前先告知可能面對的狀況及聆聽喜好的音樂等措施，來緩解疼痛，並提供傷口評估及換藥的無菌技術指導，來防止感染的產生，而在個案焦慮及陷入抉擇衝突時，採開放性的問句來進行溝通，傾聽及鼓勵其表達心中感受，給予正向的心理支持和陪伴，並提供完整的醫療照護資訊，除外鼓勵個案參與護理計劃的訂定和執行，共同評估家庭對截肢的接受程度及可能的反應，協助個案採開放式的溝通與協調，對於選擇的決策可能會面臨截肢取得共識，藉以協助個案緩解焦慮感及做出抉擇，共同擬訂出院計畫，雖然最後個案受限於傳統風俗習慣，最終的決策造成接指切除，但當個案出院後，筆者與門診護理人員交班及合作，並配合出院準備服務護理師追蹤其斷指重建復原狀態，陪伴與支持個案渡過心中的煎熬，讓個案得到持續性的護理照護。

The study aims to describe the nursing care of accompanying a young female patient with sustained traumatic finger amputation facing a dilemma between the marriage and personal health. It applied the Gordon’s 11 Functional Health Patterns as the framework. The data were collected by means of physical health assessment, direct care, and interview from Dec. 5th to 12th in 2012. The patient’s problems included acute pain, potential risk of infection, decisional conflict, and anxiety. It was through listening to the favorite music and explanation of the possible condition before changing wound dressing to release her painful suffering. The aseptic wound care was also offered to prevent the risk of infection. During nursing care, open-ended questions and psychological support including listening were provided in order to offer complete medical care information when the patient dealt with decisional conflict. In the meantime, the patient was invited to participate in the nursing care plan and operation evaluation through adopting an open-ended interview to let her express emotion and reduce anxiety. Finally, the patient decided to accept amputation due to her traditional belief. During the nursing care period, we kept providing accompany and support. We also cooperated with the outpatient department of discharge planning service to help the patient recover.