「寒灰重燃」──創傷性胸髓損傷術後青壯年之護理經驗

“Rekindling Hope”- Nursing Experience with Traumatic Thoracic Spinal Cord Injuries in a Young Adult Post-Surgery

本文描述照護一位23歲男性因車禍造成第7-9胸髓完全性損傷導致下肢癱瘓，術後返家後對未來消極被動，產生無望感，且因營養不足使胸椎術後傷口癒合差，加上家庭照顧問題再次入院之護理經驗。於護理期間2022年6月29日至2022年7月16日，以觀察、會談、身體評估及直接照護方式收集資料，運用羅氏適應模式進行整體性評估，發現個案有組織完整性受損、自我照顧能力缺失、無望感及家庭因應能力失調之四項健康問題。在護理過程中，藉由跨團隊醫療資源，提供適當傷口護理、飲食選擇建議及促進食慾之方法，以修復受損組織；共同擬定復健計劃，強化上肢肌力，以提升自我照顧能力；引導個案及家屬表達內心感受，並提供社會福利資源，讓個案對未來重燃希望，並促使家庭成員以正向積極的態度陪伴個案面對未來療程與復健。建議在照顧此類病人時，臨床人員需提高對脊髓損傷五個心理適應階段之發展，且可擅用跨團隊資源，讓病人與家屬得以獲得完整且連續性之照護。

This article describes the care provided to a 23-year-old male who sustained complete thoracic spinal cord injuries at T7 to T9 in a car accident, resulting in paralysis of the lower limbs. After returning home following surgery, he became passively pessimistic about the future, experiencing feelings of hopelessness. Furthermore, inadequate nutrition led to poor wound healing at the surgical site, which, together with family care issues, prompted the patient’s readmission to the hospital. During the care period spanning from June 29, 2022 to July 16, 2022, data were collected through observation, interviews, physical assessments, and direct care. Utilizing the Roy Adaptation Model, the assessment identified four health issues, namely, impaired tissue integrity, self-care deficit, hopelessness, and family coping dysfunction. Throughout the nursing process, interdisciplinary medical resources were utilized to provide appropriate wound care, dietary recommendations, and methods to stimulate appetite, aiding in tissue repair. Additionally, a collaborative rehabilitation plan was devised to strengthen upper-limb muscles, thereby enhancing self-care abilities. Guidance was offered to the patient and family to express their emotions and access social welfare resources, rekindling the patient’s hope for the future and fostering positive family support for subsequent treatments and rehabilitation. It is recommended that clinical staff deepen their understanding of the five psychological adaptation stages of patients with spinal cord injury and leverage interdisciplinary resources to ensure comprehensive and continuous care for both patients and their families.