燒傷患者心理社會層面之照護

Psychosocial Care of Burn Patients

醫療進步使得嚴重燒傷患者的存活率大幅提升，然而燒傷事件對於心理社會的影響甚遠，長期醫護人員的關懷與照護是必要的。常見心理社會健康問題為身體心像紊亂、社交隔離及創傷後症候群。身體心像紊亂：衝突期以歐倫自我照顧模式作為照護依據，退卻期以身體心像量表評估患者對外觀改變的看法，給予正向回饋及善用輔助物修飾外觀，接受期鼓勵盡早學習獨立自我照顧與持續復健，重建期協助患者與家人重新規劃生活與未來目標。社交隔離：將家人或重要他人併入醫療團隊，建構完善支持系統、社會資源、演練社交技能，及善用社交網絡有助於產生歸屬感，以逐步回歸社會。創傷後症候群：主動關懷、同理與察覺患者的心理變化，引導正向生命態度及強化問題解決能力，指導放鬆與轉移注意力等因應技巧以緩解焦慮和無望感，輔以認知行為治療改善患者心理狀態。醫護人員秉持以家庭為中心的照護理念，不斷增進心理社會進階照護知能，適時運用護理理論於病人及家屬之身心靈照護。

Advances in medication have significantly increased the survival rate of burn patient. However, long term care is essential for the far-reaching psychosocial influence caused by burn event. The most common psychosocial health problems are body image disturbance, social isolation, and post-trauma syndrome. The phase of care of body image disturbance includes the conflict period, the retreat period, the acceptance period, and the rebuild period. The conflict period care is based on Orem's self-care theory, the retreat period can use body image scales to evaluate how the patient think about their body image change, the acceptance period encourages patient to learn self-care independently as soon as possible and continue to rehabilitate, and the rebuild period should assist patients and their family re-planning life and goals in the future. For treating social isolation, patient's family and significant others should be involved in the care system. Establishing a complete support system, using social resources, practicing social skills, and making good use of social media can promote patient's sense of belonging and return patients to the society gradually. Applying active care, empathizing and perceiving patient's psychological changes, guiding a positive life attitude, intensifying the ability of problem-solving ability, directing techniques like relaxation and attention shifting to relieve the sense of anxiety and hopelessness, with employing the cognitive behavioral therapy to improve patient's mental status are able to relieve post-trauma syndrome. Medical staff should hold a “family-centered care” faith, advance the ability of psychosocial care continuously and apply nursing theory to the biological, psychological, and spiritual care for patient and their family timely.