位頸椎損傷個案身心健康照護與復健護理經驗

Nursing Experience of Physical and Mental Health Care for a Patient with Cervical Spinal Cord Injury

本篇描述一位中年男性因跳水造成頸椎損傷，導致下半身癱瘓失去自我照顧能力產生無力感之護理經驗。照護期間為2016年04月27日至05月12日，運用Gordon 11項評估，藉由觀察、傾聽與會談等方式收集資料，確立個案有呼吸道清除功能失效、身體活動功能障礙、皮膚完整性受損、無力感健康問題。護理過程中藉由陪伴、傾聽、接納及主動關懷，建立良好護病關係，因病人處於中壯年期，且突如其來的意外導致只能夠臥床由案妻照護，於復健過程中進步又緩慢，致使病人產生無力感，藉由鼓勵個案與案妻共同參與頸椎損傷自我照護，表達內心感受與對未來期望，以降低其無力感，增加信心；與復健師及醫師共同規劃復健計畫，以減少個案的無力感。建議鼓勵個案與案妻參加病友團體座談會，共同經驗分享與相互支持。個案正處中壯年期，因意外導致下半身癱瘓臥床、氣切管留置，對於其生活造成巨大的衝擊。引發筆者探討動機，期望藉由此護理經驗分享，提升臨床照護品質。

This report describes the nursing care of the physical and mental health and rehabilitation for a patient with cervical spinale injury from April 27 to May 12, 2016. Case assessment was conducted via physical assessment, observation, listening, and interview applying Gordon's Functional Health Patterns. Problems identified included ineffective airway clearance, physical functional impairment, impaired skin integrity, and powerlessness. Nursing process by companionship, listening, acceptance and active care, a good relationship of the care was established. Because the patient was in the prime of life, sudden unexpected result could only be bedridden by his wife. In addition, the rehabilitation process was slow, resulting in the patient feelings of weakness. It was by encouraging the case and his wife to participate in cervical spine injury self-care to express inner feelings and expectations of the future and to reduce the sense of powerlessness and increase confidence. Moreover, rehabilitation teachers and physicians planned rehabilitation programs to reduce the case of powerlessness. The plan was proposed to encourage the case and his wife to participate in symposiums of patients, common experiences and mutual support. The case was at its middle age due to accidental paralysis of the lower body caused by bed rest and gas pipe tube indwelling, exerting a huge impact on his life. This case triggered the author to explore, hoping to share this nursing experience to enhance the quality of clinical care.