一位燒傷病人及家屬面臨出院準備困境之照護經驗

Nursing care Experience in the case of a burn Patient and Family Members with Difficulties Related to Hospital Discharge Planning

本文為一位男性因意外導致顏面、軀幹及四肢燒傷面積達（Total Body Surface Area, TBSA）45％，經由四次清創重建手術後燒傷面積為TBSA 15％，關節攣縮無法維持日常生活活動之個案，主要照顧者面臨個案出院準備期間出現負向情緒因應之護理經驗。護理期間2021年12月12日至2022年1月22日，筆者藉四大系統進行評估發現個案有皮膚完整性受損、身體活動功能障礙及照顧者角色緊張之健康問題，藉由個別性傷口照護指導及營養支持促使傷口恢復，TBSA縮小至2％，提供漸進式復建計畫改善肢體關節活動功能，使個案（Activities Of Daily Living, ADL）10分進步到50分；引導案妻表達內心感受，參與出院準備計畫，提供所需知識和相關後續照護安排，使案妻能正向且有能力面對個案返家後照護，建議考量家人力量共同肩負照顧責任，未來在個案出院時，將家庭成員納入出院準備服務的一環，提升家庭照顧支持系統，降低主要照顧者壓力。

We describe a case of a male patient with burns over a total body surface area (TBSA) of 45%. After four debridement and reconstruction surgeries, the burn surface was reduced to a TBSA of 15%. Due to joint contracture, the patient was unable to perform activities of daily living (ADL). The primary caregiver faced challenges in coping with negative emotions during the hospital discharge planning period. The nursing care period was from December 12, 2021 to January 22, 2022. Assessment of the patient based on the four metaparadigms revealed health issues associated with compromised skin integrity, impaired physical activity, and caregiver stress. Wound healing was facilitated through individualized wound-care guidance and nutritional support, which reduced the burn surface TBSA to 2%. A gradual rehabilitation program for improving limb joint mobility was implemented, which enabled the patient to improve from an ADL score of 10 to 50. The patient’s wife was provided guidance on how to express her emotions and actively participate in discharge planning, as well as the necessary knowledge and related follow-up care arrangements, thus empowering her to face her caregiving responsibilities positively and competently upon returning home. We recommend that the collective strengths of family members should be considered when sharing caregiving responsibilities, and that family members should be included in the discharge planning process to improve the family caregiving support system and alleviate stress on the primary caregiver.