自我管理模式在全膝關節置換術患者之應用

The Application of the Self-management Model in Patients with Total Knee Replacement: a Case Report

本文係描述一位77歲男性病人因左膝關節炎合併高血壓接受膝關節置換術的護理經驗。護理期間自2011年8月17日至11月15日，筆者運用自我管理模式進行整體性評估，發現病人主要健康問題有下肢的活動功能受限、未規則服用高血壓藥物及未採用低鈉飲食之健康問題。藉由主動關懷，建立良好治療性人際關係後，以個別性護理照護，引導個案及家屬主動學習正確的血壓控制及全膝關節置換術後自我照護技巧，包括正確用藥、維持日常活動功能、居家肌力訓練、避免高鈉飲食及定期監測血壓等。再透過門診、家訪及電訪持續追蹤與鼓勵個案持續自我照顧及管理其疾病。此結果發現增進病人自我管理知識及自我效能，引導其持續復健的自我管理模式，能提供護理人員日後成功照顧此類臨床病人之參考。

This article described our nursing experience of caring a 77 years old male knee osteoarthritis patient with total knee replacement in his left knee from August 17 to November 15 in 2011. A comprehensive assessment of the self-management model was conducted in this study. The results showed that this patient primary experienced health problems such as limited mobility of the lower limbs, irregular use of high blood pressure medicine, and non-adoption of a low-sodium diet regime. By actively providing care and establishing excellent therapeutic interpersonal relationships, individualized nursing care was employed for guiding patients and their families to proactively learn the correct methods for blood pressure control and post-surgical self-management techniques for total knee replacement, such as regularly taking medicine, maintaining functional daily activities, performing strength training at home, avoiding high-sodium food intake, and monitoring blood pressure regularly. Through outpatient appointments, home visits, and telephone interviews, patients were provided with continuous care and encouragement to maintain self-care for disease management. The results suggested that the self-management model, which improved patients’ self-management knowledge and self-efficacies, and guided patients to continue their rehabilitations, may provide a reference to nursing staff for the care of future clinical patients with similar conditions.