運用羅氏適應理論照護一位慢性阻塞性肺疾病病人之護理經驗

Applying Roy's Adaptation Theory to Care a Patient with Chronic Obstructive Pulmonary Disease

本文探討一位慢性阻塞性肺疾病病人因疾病反覆發作入院求治的護理經驗，筆者於2016年11月26日至2017年1月7日期間運用羅式適應模式及透過觀察、直接照護、病歷查閱、身體評估與會談收集資料，歸納出有低效性呼吸型態、營養不均衡:少於身體所需及無力感之主要健康問題。照護期間教導個案胸腔復原運動，改善呼吸困難症狀|依照個案喜好多吃少餐，採高熱量高蛋白飲食，維持身體基本代謝需求|觀察個案語言及非語言行為，透過主動關懷、陪伴，建立信任感。透過與個案家人討論護理計劃並鼓勵更多的家庭成員支持和鼓勵，幫助個案與訪客互動，並鼓勵個案建立自尊心。進而達成減少再入院率與提昇良好生活品質，這次護理經驗可以使護理專業人員受益，強調自我照護和家人參與的重要性，並為護理人員將來護理相似患者提供參考。

This report described the nursing experience of applying Roy's adaptation theory to care a patient with chronic obstructive pulmonary disease. The caring period was between November 26th 2016 and January 7th 2017. Data collection was performed through direct caregiving, observation, interviews, physical assessment, and chart review. The major health problems identified included ineffective breathing pattern, imbalanced nutrition (less than body requirements), and powerlessness. Through nursing care interventions, the author provided lung rehabilitation training to improve shortness of breath. According to the patient's preference, we provided more frequent and smaller meals with and high calorie and high protein to maintain nutrition needs. By direct- caring, listening, and accompany, we established trust with the patient. By discussing care plans with the patient's family members, we encouraged family members express their supports to help the patient interact with visitors and develop his self-esteem. The caring goals were to decrease the risk of readmission and promote his quality of life. This nursing experience emphasized the importance of self-care and family participation and provided nursing staff with a reference for caring similar patient in the future.