運用Swanson關懷理論照護一位納氏漏斗胸矯正術後青少年之護理經驗

A Postoperative Nursing Experience Applying Swanson’s Caring Theory in a Teenager With Pectus Excavatum

本文運用Swanson關懷理論照護一位納氏漏斗胸矯正術後青少年之護理經驗。個案在術後除傷口疼痛及相關事項不瞭解外，並出現身體心像改變，進而影響復健與身心恢復，故引發筆者探討動機。照護期間2019年7月3日至7月10日，藉由觀察、會談、傾聽、電訪追蹤等方式進行整體性護理評估，確立急性疼痛、知識缺失、身體心像紊亂等護理問題。筆者與個案建立良好治療性關係，運用Swanson關懷理論了解個案健康照護需求，提供所需關懷及個別性護理；與個案討論及共同訂定治療選項，運用認知行為策略降低疼痛；協助個案擬定及執行個別化運動計畫，並建立正確姿勢於日常生活；協助個案術後適應外觀改變，重新認識自己、審視美的定義，維持正念面對未來。然而筆者與個案有年齡上的差距，以致花較多時間溝通使個案卸下心防，建議未來院內可定期舉辦青少年溝通課程，以提升護理人員跨年齡別溝通能力。期盼此照護經驗，能予護理人員在照護因疾病而導致身體心像改變個案之護理經驗參考及運用。

A nursing experience applying Swanson’s caring theory in the care of a teenage patient who received Nuss procedure for his pectus excavatum is described in this article. After the operation, the patient suffered from postoperative pain, lack of knowledge, and body-image disturbance. These symptoms influenced the patient’s physical and mental health, and prompted the author to do an in-depth investigation and discussion of this case. The nursing period lasted from July 3rd to 10th, 2019. The author conducted a comprehensive nursing assessment using observation, interviews, listening, and telephone interviews. The major problems identified were acute pain, lack of knowledge, and body-image disturbance. During the nursing period, the author established a good therapeutic relationship with the patient. The author applied Swanson’s caring theory to understand the patient’s healthcare needs and provide appropriate care. The author discussed the treatment direction with the patient, applied cognitive-behavioral strategies to relieve pain, educated the patient on developing and implementing individualized rehabilitation plans to establish correct posture in daily activities, and helped the patient adapt to post-operative changes in appearance and maintain a positive attitude toward the future. The age gap between the author and the patient required that the author spend additional time communicating with the patient to encourage him to open up his mind. It is recommended that hospitals offer youth communication skills lessons for nurses to enhance their communication and care skills with people of different age groups. In sharing this nursing experience, we hope to provide medical staff with a reference for caring for adolescent patients with disease-related body-image disturbance.