運用Watson 理論於一位臥床壓瘡老人及其主要照顧者之護理經驗

Applying Watson's Theory to Caring for an Older Patient with Bed Pressure Sores and Her Primary Caregiver

本文旨在描述運用Watson理論於一位臥床壓瘡老人及其主要照顧者之護理經驗。筆者於2011年6月27日至6月30日住院期間提供直接護理，出院後至8月26日3次門診探訪及6次電訪，藉由訪談、觀察、身體評估、病歷資料等方式，收集個案及其主要照顧者(案媳)在身、心、社會及靈性方面資料，結果發現個案有壓瘡傷口及營養不足的健康問題。案媳因個案產生壓瘡傷口、臥床相關照護的知識不足，以及照護人手不足，而導致照顧負荷問題。筆者運用Watson理論，與個案及案媳建立信任的治療性關係，視情況運用Watson 十項關懷照護因子，如以「增進人際間教與學的互動」提供有關的照護知識及技能，「有系統地使用創造性問題解決方法來做決定」提供個案及案媳傷口與營養照護的措施，使個案壓瘡傷口癒合良好並維持皮膚完整性，增加個案活動量及進食量；主動邀請案子參與個案相關照護的過程，也教導案子熟悉個案相關照護技巧後主動協助案媳照護個案，進而給予個案及其照顧者「激發信心與希望」；提供照顧者外界可運用的資源，如喘息服務，以減輕案媳照顧負荷；「發揮靈性的力量」以引導照顧者回顧及思考生命的價值與意義，使其能珍惜與個案相處的日子，進而維持個案良好的照護品質。

This article demonstrates applying Watson’s Theory to caring for an older patient with bed pressure sores and her primary caregiver. The nursing care period was from 27 June to 30 June 2011, along with 3 outpatient clinic visits and 6 telephone interviews after client was discharged from the hospital till August 26. Methods used to collect data were conversation, observation, physical evaluation, and review of the patient’s medical records. The nursing problems, including the client’s pressure sore wound and malnutrition and the primary caregiver burden were identified. The ten primary carative factors of Watson theory were applied to establish trust with the client and her caregiver and promot health related knowledge and support. For example, “The promotion of interpersonal teaching-learning” was used as a guideline to provide the knowledge and skills on health care. “The systematic use of the scientific problem-solving method for decision making” was used to develop a nursing care plan. The plan included providing the client and her caregiver with knowledge and skills about wound care and nutrition information, encouraging activities and food intake in order to facilitate wound healing and maintain the integrity of the skin. The author encouraged patient’s son to participate in the care process in order to provide relief for caregiver. The author provided support outside the home such as respite care to release the caregiver burden; therefore the client and her caregiver could gain “The instillation of faith-hope”. “The allowance for existential-phenomenological forces” was used to guide caregivers to review and rethink the value and meaning of life, cherish the days they spent with the patient in order to maintain the quality of care.