運用羅氏適應模式於一位脊髓損傷後自殺個案之護理經驗

A Nursing Experience Based on Roy Adaptation Model in Caring a Patient Who Committed Suicide After Spinal Cord Injury

本篇描述一位90歲脊髓損傷男性個案，因無法忍受脊髓損傷造成之疼痛、肢體活動受限而喪失自我照顧能力，飽受生、心理之苦，於案子出門時選擇割腕自殺而入院之護理經驗。筆者自2020年5月31日至6月30日照顧期間，透過觀察、會談、傾聽、直接照顧評估等方式收集相關資料，運用羅氏適應模式評估依急迫性優先處理個案急性疼痛、無望感及家庭因應能力失調等健康問題，照護過程中運用疼痛控制技巧，以期望能在最小副作用下取得最大疼痛緩解。面對無望感併自殺之個案，使用簡式健康量表密切評估自殺意念及嚴重度變化，並及早介入處置，引導個案抒發情緒、肯定自我存在的意義，避免再次自殺。同時透過家庭會談並加入家庭成員表達真實且正向的鼓勵，增強家庭支持系統，強化正向回饋機制，使個案感受被尊重與關懷，協助面對疾病所造成的影響，提升因應能力與日常生活品質，促使個案及家庭能獲得持續性的支持與照護。建議列入護理人員交班，在評估到個案屬於自殺高危險族群時，可自動連結會診精神科醫師以及轉入病房時自動警訊，期望能使醫護人員及家屬及早發現與重視個案正釋出的危機警訊，並避免再度發生，期望藉此個案照護經驗分享，提供臨床照護之應用。

This article describes the application of the Roy Adaptation Model in the care of a patient with a spinal cord injury (SCI) who experienced physiological and psychological alterations, ultimately resulting in a suicide attempt. From May 31 to June 30, 2020, the patient was evaluated through observation, interviews, listening, and direct care, and assessed using the Roy Adaptation Model to prioritize urgent issues, including acute pain, hopelessness, and impaired family coping skills. The primary goals were to achieve maximum pain relief with minimal adverse effects and to address the client's hopelessness and suicidal ideation. Through family counseling, the client and caregiver were encouraged to express their emotions, and positive reinforcement was provided to enhance the family's coping skills, ensuring the client received ongoing support. In retrospect, it is recommended that primary nurses ensure a thorough handoff for such cases, enabling early intervention, prompt psychiatric consultation, and recognition of crisis warning signs to prevent similar tragic outcomes.