以關懷理論照護一位癱瘓後無望感個案之經驗

本文敘述一位因車禍導致頸椎第6、7節椎間盤破裂脊髓損傷合併腦震盪造成雙下肢癱瘓，面臨身體突如其來的遽變，對未來產生嚴重心理衝擊，引發無望感個案之護理經驗。護理期間自2020年8月18日~9月20日，運用生理、心理、社會及靈性評估經觀察會談、臨床照護、病歷查閱等方式收集，分析歸納確立個案有「無望感」、「身體活動功能障礙」、「家庭因應能力失調」之健康問題。照護期間，筆者以Swanson關懷理論為基礎，與個案建立治療性關係，以同理、傾聽、瞭解個案健康需求，引導表達自我感受，適時給予支持與正向鼓勵，提供正確疾病資訊，讓個案參與醫療決策，增加對疾病自主權。藉由個案的植栽興趣，給予個別性照護，引發對生命力的嚮往及紓解心理壓力，協助渡過無望感危機。共同擬定復健計畫，促使個案增強肢體肌肉力量，增進其自我控制感，發揮最大的身體功能改善自我照顧能力，克服生活障礙。與家屬共同擬定住院照護分配表，強化家庭支持系統，提供出院照護規劃及長照資源，希望藉此照護經驗分享，提供護理同仁臨床實務參考。

This article described the nursing experience of care a patient who paralysis of both lower limbs due to a C6-C7 intervertebral disc rupture, spinal cord injury, and concussion from a traffic accident who were facing enormous physical change and severe intrapsychic conflict leads to hopelessness. The nursing process extended from August 18th to September 20th, 2020, involving data collection through interviews, observations, clinical care, and review of medical records. The associated health problems, including hopelessness, impaired physical mobility, and ineffective family coping, were addressed through an integrated approach encompassing physical, psychological, social, and spiritual domains. Drawing on Swanson’s caring theory and emphasizing empathy, active listening, and individualized care, the author provided support to both the patient and family members, guiding them through the crisis of helplessness and aiding in the formulation of a recovery plan. Efforts were made to promote self-care capacity and overcome life barriers, with an emphasis on collaborative planning and scheduling of inpatient care involving family members. Discharge planning and long-term care resources were also provided to ensure ongoing support. This sharing of care experience is expected to serve as a valuable reference for nurses in clinical practice, highlighting the importance of holistic care and the role of empathy and understanding in promoting patient and family well-being.