一位頸髓損傷患者復健期的護理經驗

The Nursing Experience for a Patient Receiving Rehabilitation after Cervical Spine Injury

本文旨在探討一位頸髓損傷患者術後復健期的照護經驗，本個案為54歲，因車禍造成第三至六頸髓損傷導致上肢無力及下肢癱瘓，失去自我控制感到無力與被動。筆者於2009年8月5日至8月20日護理期間，採Grodon十一項健康功能型態評估，以觀察、會談、身體評估與查閱病歷等方式收集資料，確認主要的健康問題為：排尿型態障礙、身體活動功能障礙、無力感等。經由護理過程提供個別性護理措施，運用同理心、傾聽、陪伴等技巧及提供個案和家屬有關脊髓損傷復健資訊，並教導照護者學習間歇性清潔導尿，改善個案導尿管有關之泌尿道感染；協助個案和家屬面對肢體復健，個案逐漸能表達對疾病的感受，能主動參與復健運動，談話中能呈現正向自我概念，期望藉此經驗作為日後護理人員照護此類病患之參考。

This article describes a nursing experience for a patient receiving rehabilitation after cervical spine jujury. A 54-year-old man suffered from a cervical spine injury（C3-6）due to a motor vehicle incident. Both of the patient's lower limbs were paralyzed, and both arms were also weak. Since the incident, the patient had been feeling powerless and passive because of a loss of self-control. The nursing care period was from August 5 to 20, 2009.Gordon's Functional Health Assessment Model was applied. Through the use of an interview, direct observation, physical examinations, and a patient chart review, the three identified major nursing problems were impaired urinary elimination, impaired physical mobility, and feelings of powerlessness. The author provided individualized patient care through empathy, active listening, and physical presence. Rehabilitative information regarding spinal injury, and intermittent catheterization and catheter-associated urinary tract infection were provided to the patient and family members. The patient, who was originally tortured by the illness, later became actively proficient in self-care skills, participated in the motor rehabilitation, and expressed positive self-esteem.Hope that this report will be a valuable clinical reference to other nursing staffs.