一位多處肋骨併左鎖骨骨折術後病人之照護經驗

Nursing Care Experience for a Patient with Multiple Ribs and Left Clavicle Fracture Undergoing Surgery

本文探討一位意外事故創傷，導致多處肋骨併左鎖骨骨折病人術後，因疼痛導致個案在自我照顧需求上無法滿足，引起負向情緒，引發筆者深入探討。照護期間為2018／5／29至6／5，運用Gordon十一項功能性健康型態評估進行整體性評估，藉由觀察、會談、傾聽及身體評估等方式收集資料，確立個案健康問題有急性疼痛、組織完整性受損、焦慮等。於照護過程中，予傷口換藥前播放大自然相關音樂分散個案注意力，提供翻身枕及三角巾支拖疼痛部位，減輕活動過程中引起的疼痛，錄製傷口換藥教學影片提供家屬傷口照護指引，並每日安排10－20分鐘陪伴個案，採開放式溝通，引導個案表達內心感受，建立信任的護病關係，鼓勵個案共同參與照護活動，當個案有進步時給予口頭鼓勵，減輕個案面對術後無法自我照顧的不安情緒。術後病人照護除了即時解決生理問題，建議可使用簡易「焦慮視覺類比量表」，儘早評估並適時介入合宜護理措施，降低因焦慮引發其他相關生、心理問題，增進自我控制感及信心，以重建個案正向的身心調適，進而提升個案生活品質，儘早回歸社會。

This article described the nursing experience of caring a patient who underwent a surgery for a trauma-induced multiple ribs and left clavicle fracture. After the operation, the pain disabled the patient and consequently induced negative emotions. The period of patient care was from May 29, 2018 to June 5, 2018. Gordon 11 Function Health Patterns, collecting data through observation, interviews, listening, and physical assessment, were used for a holistic assessment. Health problems of the patient included acute pain, impaired tissue integrity, and anxiety. During the period, we distracted the patient with nature music before wound dressing, provided the role-over pillow and the sling to the affected part, reduced the pain during the activity, recorded the process of wound dressing to guide the family, and accompanied the patient for 10 to 20 minutes every day. We communicated openly, guided the patient to express his feelings, built trust, encouraged him to participate in activities, complimented him when improving, and reduced his uneasy feelings that had been existing since surgery. In addition to solving physical problems immediately after surgery, it was recommended that the simple ''Anxiety Visual Analog Scale'' can be used for assessment and intervention to reduce other related physical and psychological problems caused by anxiety. This could enhance self-control ability and confidence, reinforce positive physical and mental adjustment, and ultimately improve patient's quality of life.