照顧一位外籍勞工斷指重建失敗後截肢之護理經驗

Nursing Experience of Caring for a Foreign Worker Undergoing Amputation after the Failed Severed Finger Replantation

本文描述一位外籍勞工因工作不慎斷指，面臨重建手術失敗而接受截肢之護理經驗。筆者於2012年11月24日至12月11日護理期間，運用Gordon十一項功能性健康評估為工具，藉由實際照護、觀察、會談、身體評估及病歷查閱等方式收集資料，確立主要護理問題為急性疼痛、組織完整性受損與無望感。筆者透過提供個別與整體性照護，藉由疼痛評估掌握疼痛程度，協助採取舒適臥位，提供深呼吸及轉移注意力，改善術後疼痛。每班觀察傷口感染徵象，依無菌技術予以傷口護理，指導案友接觸個案前後洗手，衛教攝取高蛋白飲食，促進傷口癒合。提供祈禱室運用宗教力量幫助其沉澱心情。以同理心態度建立良好護病關係，傾聽其抒發內心感受，介紹調適良好之病友，透過經驗分享引導其逐漸面對肢體失能的事實，並主動參與未來規劃。會診社工師運用相關社服資源，協同雇主、仲介與個案共同討論出院後因應策略，使其儘早學習自我照顧與適應生活。期望本護理經驗能提供面對意外造成截肢的外籍勞工，需結合相關社會資源，重視其創傷後的心理反應，及早回歸原有生活。

This paper described the nursing experience for a foreign worker who underwent amputation after the failed replantation of a severed finger that had been the result of carelessness in the work. The period of care extended from November 24 to December 11, 2012. Gordon’s 11 functional health patterns were used to collect data through practical care, observations, interviews, physical assessments, and medical record review. It was confirmed that the main nursing problems were acute pain, impaired tissue integrity, and hopelessness. In order to relieve postoperative pain, the author provided individualized holistic care, understood the degree of pain through pain assessment, helped the patient lie comfortably, and provided deep breathing and attention shifting techniques. The wound was observed during each shift to check for infection and wound care was performed using aseptic techniques. The friends of the patient were instructed to wash their hands before and after contact with the patient. Health education instructed the patient to maintain a high protein diet to promote wound healing. A prayer room was also provided to relax the patient. The author’s empathetic attitude helped establish a good nurse-patient relationship; this included listening to the patient’s feelings, introducing similar patients who adjusted well, and sharing experience to help guide the patient in facing the disability and making future plans. The author used social service resources to discuss post-discharge coping strategies with the employer, intermediary, and the patient to teach the patient self care techniques in order to adapt to life as early as possible. This nursing experience can help other foreign workers undergoing amputation as a result of an accident. Relevant personnel are suggested to integrate social resources and pay particular attention to their psychological reactions after such traumas so as to help them return to their original life as early as possible.