一位學齡期兒童因斷指接受顯微重建之手術全期護理

An Experience of Perioperative Nursing for a School-age Child Receiving Microsurgery and Replantation of Amputated Fingers

本文是在探討一位8歲學齡期兒童因在學校遊戲時，不慎造成右手食指及中指斷指，接受顯微重建手術之手術全期護理經驗。護理期間為2021年4月16日至2021年4月26日，筆者在手術前、中、後期運用觀察、會談、病歷查閱及直接照顧等方式收集資料，以手術全期為基礎，評估生理、心理、社會及靈性層面之健康問題，確立個案有手術前期恐懼、手術中期潛在危險性傷害、手術後期急性疼痛等健康問題。在手術全期護理過程中，筆者藉由主動傾聽與關懷，針對學齡期兒童提供術前衛教影片，用口述及繪圖方式說明手術相關流程，並針對斷指手術後傷口照護的重要性，給予個別性衛教及護理，增加個案對手術的了解來降低恐懼；手術中提供正確擺位及適當保護，預防不可逆的手術風險發生；手術後教導個案使用影片、音樂轉移注意力、教導深呼吸技巧及協助正確臥位來降低疼痛感。對學齡期兒童來說，手術環境不熟悉是恐懼的常見因素，急診病人更無法完整獲得手術及麻醉相關資訊，影片對學齡期兒童來說是有效降低負面情緒的工具，建議能提供手術相關流程衛教影片，讓病童盡早得知更完整的內容，增加對手術的了解來降低恐懼及不安。

This article explores the nursing experience of caring for an 8-year-old school-age child who underwent reconstructive microsurgery due to the accidental amputation of the right index and middle fingers while playing at school. The author used perioperative nursing care as a foundation, gathering data from April 16 to April 26, 2021, through observation, interviews, chart reviews, and direct care before, during, and after the surgical procedure. This report analyzes the physical, psychological, social, and spiritual health challenges encountered during the perioperative period, including potential preoperative fear, risk of injury during surgery, postoperative acute pain, and other health concerns. During the perioperative nursing process, the author provided preoperative education through a video, used active listening and caring techniques, and employed verbal and visual methods to explain the essential aspects of the surgery. Given the need for wound care after finger amputation surgery, specific health education and nursing interventions were provided to enhance the child's understanding of the procedure and alleviate anxiety. The author also ensured optimal positioning and protection during surgery to prevent irreversible surgical risks. After the surgery, videos and music were used to distract the patient, while deep breathing techniques and proper sleeping positions were taught to help alleviate pain. Unfamiliarity with the surgical environment was a major source of anxiety for the child, and emergency patients often lack complete information about surgery and anesthesia. Using videos proved to be an effective method for reducing negative emotions in school-age children. It is recommended that surgical procedures be explained through educational videos, as they help hospitalized children quickly absorb comprehensive knowledge, enhance their understanding of the surgery, and reduce fear and anxiety.