照護一位遭機械性傷害併左肘下截肢病人之護理經驗

A Nursing Care Experience for a Patient with Lower Left Elbow Amputation Resulting from Mechanical Injuries

本文為照護一位因工作時左手不慎被機器捲入，造成左肘下截肢個案的護理經驗。筆者於2014 年4 月7 日至5 月1 日在照護期間，運用觀察、會談、傾聽、查閱病歷等方式收集資料，以Gordon 十一項功能性健康模式做整體性評估，確認個案的主要健康問題有急性疼痛、現存性感染、自我照顧能力缺失及身體心像紊亂等，在護理措施包括：以聆聽音樂、深呼吸技巧及興趣的話題等護理措施來轉移疼痛的注意力；提供傷口相關照護訊息、教導傷口自我照護，來降低傷口感染以促進組織的癒合；教導自我照顧技巧，給予正向鼓勵，能儘早恢復日常生活的能力；提供社會資源相關訊息，介紹成功案例分享心路歷程，分享無四肢的演講家尼克" 半身奇跡" 用心擁抱世界的故事，來激勵個案的自信心，活出自我，儘早適應因身體心像的改變所帶來的衝擊，以助其能建立正向的身體心像。

This article discussed the nursing care experience for a patient with lower left elbow amputation as a result of machinery accident that dragged his left hand into the machine. During the care period from April 7th to May 1st in 2014, the author collected data through observation, interviews, listening, and patient chart review. Gordon’s 11 functional health patterns assessment was utilized to evaluate the patient, and it was determined that the case was prone to acute pain, infection, self-care deficiency and body image disturbance. The patient was provided with music, deep breathing technique, and interesting conversation topics to shift his attention to help reduce pain. In addition, education for wound care and information related to infection risk are also provided to help minimize infection, as well as to promote wound healing. The patient was trained for self-caring techniques and given positive feedback to improve his ability to resume normal daily activities. Furthermore, appropriate social support is provided, and patients with similar experience are invited to share their stories. The inspirational story of Nick Vujicic on embracing the world with a brave heart is also shared with the patient to increase his confidence and the ability to adapt to physical and mental changes caused by the injury in order to help patient restore and build a positive image.