照顧一位重度燒傷病人併無望感發生之加護經驗

An Intensive Nursing Experience about Caring a Major Burn Patient with Hopelessness

本文描述照護一位中年肥胖男子因自家餐廳氣爆，造成56％全身體表面積（Total body surface area,TBSA）重度燒傷，治療過程中因腎臟功能急速惡化因此需接受血液透析治療、傷口換藥疼痛及艱辛復健過程，所產生無望感之加護經驗。筆者照護期間自2015年3月3日至6月15日，藉由觀察、會談、身體評估及實際照護等方式收集資料，依個案生理、心理、靈性及社會層面評估，確立個案有：（1）現存性損傷/與吸入性灼傷引起肺泡上皮細胞發炎受損有關、（2）組織完整性受損/與燒傷導致真皮層受到破壞有關、（3）急性疼痛/與協助傷口換藥及執行復健運動有關、（4）無望感/與對重度燒傷需長期復健及接受血液透析治療感到沒希望有關、（5）營養狀況少於身體所需/與身體肌肉流失及熱量和蛋白質大量耗損有關等五項健康問題，礙於篇幅問題，僅針對前四個健康問題給予適當護理措施與評值。經由跨團隊專家討論，提供適當介入措施，使其燒傷傷口漸趨癒合及緩解換藥疼痛，並透過病友心路歷程分享及轉介陽光基金會團體，進而提升個案對生命的熱忱與希望。冀望藉此經驗分享，能提供護理人員照護燒傷病人時之參考。

This article describes the nursing experience of a middle-aged obese man after gas explosion in their own restaurant, resulting in 56% of the total body surface area major burns. During the nursing process, due to the function of the patient's acute renal failure, he needed to receive the treatment of hemodialysis. However, because of the painful wound dressing and the difficult process of rehabilitation, the patient felt hopeless. The nursing period started from March 3rd to June 15th in 2015. Data were collected by observation, interview, physical assessment, and practical physical caring, and were evaluated by physical, psychological, spiritual and social level assessment. We identified that the patient had five major health problems, including existing damage, impaired tissue integrity, acute pain, hopelessness, and insufficient nutrition. The authors reported only the first four health problems to give appropriate nursing intervention and evaluation. By discussing with experts of multiple fields for appropriate interventions, the wound was recovered gradually and the painful wound dressing was also mitigated. Some successful experiences were also shared to the patient by other burn patients, and referred him to Sunshine Social Welfare Foundation. By this nursing experience sharing, it is hoped that it can provide the staffs how to take care of these kinds of patients.