運用Swanson關懷理論照護一位初次診斷馬凡氏症候群併主動脈剝離病人之護理經驗

Applying Swanson's Caring Theory to a Patient With an Initial Diagnosis of Marfan's Syndrome With Aortic Dissection

本文運用Swanson關懷理論照護一位初次診斷馬凡氏症候群年輕男性，因A型主動脈剝離，需行主動脈根部置換手術。個案為香港交換學生，無可依賴的親友在身邊，初次得知罹患疾病且面臨重大手術抉擇，此時身心靈需求評估極為重要，如未即時處理將影響預後甚劇，此為筆者的選案理由及探討動機。照護期間為2020年4月13日至4月18日，以生理、心理、社會與靈性四層面評估確立個案有身體心像紊亂及焦慮之健康問題。筆者於照護中運用Swanson關懷理論中的五大過程，於「了解」及「在旁陪伴」的過程，透過主動陪伴及關懷，建立信任關係，傾聽個案內心對疾病的想法，評估個案的需求並接受其負向的情緒；使用「為他做某事」及「使他能夠」的概念，擔任親情溝通橋樑，使雙方達成共識，並鼓勵面對問題，適時給予協助，促進自我調適，減輕心理衝擊不安，降低焦慮。透過護理指導增加術後照護及相關疾病知識，培養自我照護能力，使其能接受現況並積極參與治療。最後於「維持信念」過程，透過實際的狀況給予正向的回饋，並介紹相同病友彼此交流，提供維持正向前進的動力。照護過程除了護理人員的陪伴與照護，親友的心理支持更是不可或缺，因此建議重症照護者應強化關懷能力以提升照護品質，將此經驗提供臨床工作者參考。

This article describes the author's experience using Swanson Care Theory in the provision of nursing care to a 20-year-old man, an exchange student from Hong Kong, following his initial diagnosis with Marfan's syndrome. This patient required emergency aortic root replacement surgery due to type A aortic dissection. Immediately after learning of his illness, the patient was faced with making a major surgical decision. The absence of relatives and friends close by to assist him made him unable to decide whether to agree to the operation. Because of the importance of evaluating the physical and mental needs of the case, which would affect his prognosis, the author conducted a four-facet physical, psychological, social, and spiritual assessment of the patient from April 13-18, 2020. The results confirmed the presence of significant health problems, including “body image disturbance” and “anxiety”. The author applied the five processes of Swanson's caring theory in caring for this patient. The process of “Knowing” and “Being with” helped, through active companionship and care, establish a trusting relationship, elucidate the client's inner thoughts on the disease, evaluate the client's needs, and accept the negative emotions. The process of “Doing for” and “Enabling” were employed to serve as a bridge for family communication to help both parties achieve consensus and to encourage effective problem-facing, provide timely assistance, promote self-adjustment, and reduce psychological shock, unease, and anxiety. Health education was implemented to increase the patient's disease and postoperative-care knowledge and promote self-care abilities to facilitate his acceptance of the current situation and active participation in treatment. Finally, the process of “Maintaining belief” was used to elicit positive feedback through actual situations. Patients with conditions similar to this patient were introduced to share their experiences and provide empathy to provide our patient with the motivation necessary to maintain positive progress. Based on this experience, it is recommended that critical caregivers strengthen their caring ability to improve their quality of care. This experience is may be referenced by clinical workers.