一位非預期接受胸腔鏡手術個案之護理經驗

Nursing Experience of an Unexpercted Thoracic Surgery Patient

本文是描述一位獨居男性,因肺炎併發肋膜積液惡化為膿胸,接受非預期胸腔鏡肋膜剝除手術,面臨身心衝擊之護理經驗。護理期間為 2014/09/15-09/27,運用Gordon 十一項健康功能型態評估,藉由觀察、會談及傾聽等技巧收集資料,確立主要健康問題有體溫過高 / 肺炎併發膿胸及胸管留置有關;急性疼痛 / 胸管留置及手術傷口受牽扯有關;手術前焦慮 / 家庭支持系統薄弱、對健康造成威脅、對手術過程、預後及術後照顧不了解有關。在照護過程中,執行發燒的舒適護理及跨團隊醫療小組的照護;教導疼痛控制技巧,促進身體舒適,並提供活動式胸腔引流瓶置放架及鼓勵欣賞音樂會,促進及早下床活動;適時表達關懷個案,建立良好護病關係,促使個案願意分享內心焦慮的感受,並聯繫案姐及案子陪伴,進而引導參與術前、後照護,增強親情支持,運用多媒體介紹胸腔鏡手術,在護理人員的引導及陪伴下,透過輔助療法及介紹成功個案與其會談,使個案能從他人經驗中增強信心,減輕焦慮,更協助戒菸成功。經此照護經驗深刻了解身體健康與心理層面是相互影響,建議單位針對手術前個案心理層面,加強正確評估及處置能力,將有助於達到更完善之護理品質。

This article depicts nursing experience of dealing with the physical and physiological effects of nursing on a single male client - who lived alone, and under-went unexpected thoracic surgery. The nursing period was from the 15th to 27th of September, 2015. Gordon’s functional health patterns were used in the assess-ment; data collection was performed based on observations, interviews, listening, and other skills. It was established that major health problems included hyperther-mia/pneumonia complicated by empyema, acute pain related to chest tube and surgical wounds, and anxiety. Preoperative anxiety and weak family support were health threats because the family did not understand the surgery, prognosis or postoperative care. While nursing, fever care and interdisplinary medical team care were performed, and pain control techniques were also used to improve physical comfort and quality of sleep. Additionally, a portable chest drainage system was provided and the patient was encouraged to enjoy music concerts. These successful supports promoted the patient’s movement and prevented complications. A good relationship between the patient and the nurse was established by showing concern periodically, and by encuraging the patient’s willingness to share his anxieties and feelings. The patient’s sister was contacted and guided to promote family support before and after the operation. Thoracic surgery was introduced using multimedia devices. The patient’s confidence level increased, and his anxiety level decreased. This patient also successfully quit smoking under the guidance and company of the nurses, with the use of complementary therapy through introduction and conversations. This nursing experience provided a deep understanding of the inter-dependency of mental and physical health. This article recommends that health care providers use positive psychiatric assessment and abilities to help the coping of surgical patients. This approach can decrease the anxiety of the patients and achieve a better quality of care and confidence.