運用羅氏適應模式照顧一位青少年因意外截肢之護理經驗

本文敘述一位18歲逃家在外獨居的青少年個案，因車禍造成左腳背開放性骨折併部分肢體發黑腐爛接受非預期截肢及補皮之護理經驗。筆者自2015年4月28日至5月30日照顧期間，透過觀察、會談、傾聽、直接照顧評估及查閱病歷等方式收集資料，運用羅氏適應模式評估方法，發現個案依序有急性疼痛、身體活動功能障礙及身體心像紊亂等健康問題，照護過程醫療團隊運用疼痛控制技巧，期能在最小副作用下取得最大疼痛緩解；教導漸進式復健運動以維持四肢肌力和關節活動度，提供輔具相關資訊，讓個案盡早恢復獨立自我照顧生活；瞭解個案對外觀改變的感受及想法，協助接受截肢事實，透過個別性護理及疾病照護資訊，提升個案及家屬的調適能力、日常生活品質及照護能力等措施。建議照護團隊在個案出院前可先轉介出院準備並定期舉辦病友會，讓個案可獲得持續性的支持，適時追蹤經濟狀況，提供就業機會及福利資源等。 This article describes an 18-year-old youth living alone outside the home. He suffered a car accident that caused an open fracture of the left foot and part of limb necrosis. Unexpected amputation and skin replacement were arranged. The patient had to face wound pain, relying on others for physical incapacity, and physical activity changes. During the period from April 28 to May 30, 2015, Used observation, conversation, listening, direct assessment, and review of medical records. By using Roy's adaptive model as an assessment model to collect data, it was found that there were health problems such as acute pain, physical activity dysfunction, and body image disturbance in the sequence. The team care used pain control techniques to achieve relieving maximum pain with minimal side effects. Instructing the patient in progressive rehabilitation exercises to maintain the muscles strength and joint mobility of the limbs, and providing supplementary information for him, and to allow individuals to resume independent selfcare as soon as possible. Understood the patient's feelings and thoughts on the appearance change, assist in accept the fact of amputation, through the individual nursing and disease care information, and improved the adjustment ability, daily life quality and care ability. It is recommended that the team refer the patient to discharge planning before discharged, convene the regular meetings that patients can receive continuous support, economic conditions, employment opportunities and welfare resources.