運用平衡鎮痛及副作用理論護理一位全膝關節置換術後病人疼痛之經驗

Applying a Middle-Range Theory of a Balance between Analgesia and Side Effects to a Patient having Total Knee Replacement on a Postoperative Pain: A Nursing Experience

本文運用Good 及Moore 發展之「平衡鎮痛及副作用之中型理論」深入評估及照護一位行全膝關節置換術後個案之疼痛健康問題。此理論曾被運用於術後及癌症疼痛，除重視病人藥物使用及副作用之評估外，並介入非藥物止痛方式及病人衛教，在處理病人疼痛過程中強調持續評估與重新介入措施之重要，期能在最小副作用下取得最大疼痛緩解。剛接觸個案時發現個案有急性疼痛、睡眠及活動等問題，且所使用之強效止痛劑及輔助性藥物未能有效緩解其疼痛，並因疼痛無法緩解而造成個案活動受限並影響其睡眠，因此評估急性疼痛為其主要問題。照護期間為2013 年4 月17 日至4 月19 日，運用此中型理論重新評估個案疼痛，並與其討論後訂立目標，再依此目標重新介入措施。在照護期間，除個案原本使用藥物(morphine 及cataflam) 外，再介入非藥物輔助( 如冰敷及漸進式肌肉放鬆) 措施及給予個案相關衛教，最後達到個案所期待之疼痛緩解。期望能將此運用理論並以病人為中心之實證照護經驗，提供臨床護理人員參考，以有效減緩解病人術後疼痛。

This article describes the application of Good & Moore’s Middle Range Theory of a balance between analgesia and side effects to assess and care for a postoperative total knee replacement patient. This theory has been applied in postoperative and cancer pain. The theory not only focuses on pain medication and regular assessment of pain and side effects, but also intervenes with nonpharmacological adjuvant and patient education. At the same time, this theory emphasizes the importance of reassessment and reintervening to achieve the maximal pain relief under the minimal side effects. At initial assessment, the author found that the patient encountered acute pain, sleep and activity problems, and the potent pain medication and pharmacological adjuvant that patient used could not relieve her pain effectively. Moreover, her unrelieved pain affected her activity and sleep. Pain was the major problem, therefore this Middle Range Theory was used to reassess patient’s pain, and reintervene after setting a mutual goal from April 17th to 19th, 2013. Except patient’s drugs (morphine and cataflam), non-pharmacological adjuvant (ice compress and progressive muscle relaxation) and patient education also be applied to relieve patient’s pain. The author found that the balance between analgesia and side effects theory can be used successfully for assessing and intervening acute postoperative pain in a total knee replacement patient. The theoryand evidence-based caring experience would provide nurses with a reference for pain relief while taking caring patients after total knee replacement.