照顧一位肩旋轉肌袖斷裂病人行關節鏡之手術全期護理經驗

Surgical Nursing care Experience of a Patient who Underwent Arthroscopic Rotator Cuff Repair

本文描述一位中年婦女，因右肩旋轉肌袖撕裂行旋轉肌袖修補之手術全期護理經驗。筆者於2019年04月21日至04月24日護理期間，藉由術前訪視、術中照護與術後探視，運用觀察、會談及查閱病歷等方式蒐集資料，依手術全期照護，進行整體性評估，歸納分析後，確認個案有焦慮、體溫過低及急性疼痛之健康問題。在手術全期護理過程中，筆者藉由主動傾聽與關懷，耐心傾聽其感受，陪同做深呼吸放鬆技巧，並提供手術及麻醉過程相關資訊，及兩項傷口照顧及復健注意事項以減輕其焦慮；手術中期正確擺位及適當防護，並主動給予病人加溫保暖改善低體溫；手術後採合宜臥位，教導深呼吸轉移注意力方法，以降低疼痛，讓個案在安全舒適之手術過程順利出院。建議醫院可編制骨科醫療品質團隊，包括手術護理師、醫師、復健個案管理師與復健師，繼續出院居家照護，使病人獲得持續的照護，提升醫療照護品質。期能藉此經驗分享，作為日後護理人員臨床照護之參考。

This article describes the nursing experience of a middle-aged woman who underwent arthroscopic repair of a rotator cuff tear in the right shoulder. Between April 21 and 24, 2019, we collected data through preoperative and postoperative visits and intraoperative care, as well as from observations, bedside interviews, and a review of medical records. We employed the perioperative care model to conduct an overall assessment and generalized analysis, and it was confirmed that the patient had experienced anxiety, hypothermia, and acute pain. During the perioperative nursing care period, we proactively listened and provided care to the patient, put in the effort to understand her concerns, accompanied her to the operating room and taught her deep breathing and relaxation techniques, and provided her with information about the surgical and anesthesia procedures, as well as two wound care and rehabilitation advisories to reduce her anxiety. The patient was properly positioned and protected during the operation and proactively warmed to prevent hypothermia. After the operation, the patient was placed in an appropriate position and advised to do deep breathing exercises to divert attention and reduce pain, thus helping her feel safe and comfortable and be discharged uneventfully. We recommend that hospitals form an orthopedic quality team comprising surgical nurses, physicians, rehabilitation case managers, and physical therapists for home care after discharge, so that patients can receive continuous care and experience a higher quality of medical care. We aim to share this experience as a reference for clinical nursing staff in the future.