照顧一位創傷性足三踝骨折病人之手術全期護理經驗

Perioperative Nursing Experience on a Patient with Traumatic Trimalleolar Fracture

本文是在敘述一位創傷性足三踝骨折病人，於急診等候接受開放式復位鋼板內固定術之手術全期護理經驗。筆者於2016年02月20日至02月26日護理期間，在手術前、中、後期藉由觀察、傾聽、會談、身體評估及查閱病歷等方式收集資料，並以手術全期照護模式為評估架構，確立個案有焦慮、潛在危險性手術情境的傷害及潛在危險性周邊神經血管功能失常等健康問題。在手術全期護理過程中，筆者藉由主動傾聽與關懷，針對急診等候入手術室之個案的需求，提供手術相關資訊，增進個案對骨折手術及麻醉的了解，減輕手術前期的焦慮；手術中期提供正確擺位及適當防護，以預防不可逆的手術風險發生；並針對骨科手術病人，術後可能發生之神經血管損傷之風險，給予個別性衛教及護理，讓個案在安全舒適之環境下能順利出院。因急診等候手術病人無法完整獲得手術及麻醉相關資訊，易引發焦慮問題，建議護理人員能運用手術前衛教短片或衛教單張，以協助急診等候接受手術病人心理上能更早適應及減輕壓力，進而提升手術照護品質。 This study describes the perioperative nursing experience on a patient with traumatic trimalleolar fracture waiting for undergoing Open Reduction Internal Fixation (ORIF) at the ER. During the nursing period from February 20 to February 26, 2016, the researcher adopted methods of observation, listening, interviews, physical evaluation, and medical chart review. Data were collected before, during, and after the surgery. In addition, perioperative nursing care model was used as the evaluation framework to confirm that the patient experienced health issues, such as anxiety, potential risk for operative injury, and potentially dangerous peripheral neurovascular dysfunction. During the perioperative nursing, the researcher proactively listened to and cared for the patient at the ER waiting for undergoing the surgery by understanding the patient's needs, providing surgery-related information, increasing the patient's understanding of fracture surgery and anesthesia, and reducing the perioperative anxiety. During the surgery, the researcher provided correct positioning and adequate protection information to the patient, in order to prevent the occurrence of irreversible surgical risk. Moreover, for patients undergoing orthopedic surgery, the researcher provided them with individualized health education and potential risk of postoperative neurovascular injury to enable the patient to be discharged from hospital in a safe and comfortable state. Because patients waiting for undergoing surgery at the ER are unable to obtain complete information on surgery and anesthesia, thus may trigger anxiety problems, nursing personnel are advised to use perioperative health education short films or health education leaflet to assist patients waiting for undergoing surgery at the ER in mentally adapt themselves to the surgery and reduce pressure as early as possible to further improve surgical care quality.