運用Swanson 關懷理論於一位多重創傷個案之加護護理經驗

Nursing Experience of Caring a Patient with Multiple Trauma by Applying Swanson's Caring Theory

本文為運用Swanson關懷理論於一位多重創傷個案之加護護理經驗。在突發與危及性命情形下入住加護病房，對病人來說，是一個重大壓力事件，除需面對身體不適外，在身處陌生及封閉的環境、監測儀器及多重管路留置的狀況下，容易恐懼、焦慮，若未及時處置，會影響病人身體恢復時間並延長住院天數。本文個案因初次住院又身處加護病房，對於儀器的警告聲響及身上的管路感到害怕，擔心身體創傷是否能恢復及是否會面臨死亡的威脅，引發筆者探討的動機，照護期間為2021年5月31日至6月4日，經由觀察、筆談、會談、傾聽、直接照護及身體評估等方式蒐集資料，確立個案有急性疼痛、組織完整性受損及焦慮等健康問題。護理措施包含以CPOT疼痛評估量表評估疼痛指數、協助穴道按摩、使用束腹帶固定傷口，及給予個案聆聽喜愛的電台節目轉移注意力，減輕疼痛之問題；透過評估傷口狀況及滲液、以無菌技術換藥，並提供合適的敷料，促進傷口癒合及避免發生感染；鼓勵個案表達感受，給予陪伴以及協助執行自我照顧及參與治療計畫，使個案能克服因初次入住加護病房及對於疾病不了解所致的焦慮，協助個案度過因意外造成的傷害，重返正常生活。期望藉此護理照護經驗日後能提供臨床照護之參考。

This is the nursing experience of a patient with multiple trauma, using Swanson's Theory of Caring. Admission to the intensive care unit (ICU) due to a sudden or life-threatening event is a highly stressful experience for patients. In addition to physical instability, patients are often placed in an isolated and enclosed environment surrounded by various monitoring devices, drains, and tubes, which can lead to feelings of fear and anxiety. Failing to understand the patient’s needs may hinder physical recovery and extend their stay in the ICU. The motivation for this discussion stems from a case in which a patient was admitted to the ICU for the first time due to a sudden event and unstable condition. The patient was frightened by the warning sounds of medical instruments and the tubes attached to their body, and was concerned about whether their physical trauma could heal and whether they faced a risk of death. The nursing care period lasted from May 31 to June 4, 2021. Data collection was based on observation, written communication, interviews, active listening, direct care, and physical assessment. Three primary health problems were identified: acute pain, impaired tissue integrity, and anxiety. Nursing interventions included: (1) Pain relief: Using the CPOT pain assessment scale to measure pain intensity, applying acupressure and massage, using an abdominal binder, and providing the patient’s favorite radio programs to distract them during dressing changes. (2) Wound healing and infection control: Assessing wound conditions and exudation, changing dressings using aseptic techniques, and ensuring adequate nutrition. (3) Anxiety alleviation: Encouraging the patient to express their feelings, offering companionship, and assisting with self-care and participation in the treatment plan. The nursing care provided helped the patient overcome anxiety caused by the ICU environment and lack of understanding about their condition. It also supported the patient in recovering from the injuries sustained in the accident, ultimately allowing them to return to normal life. It is hoped that this nursing experience will serve as a valuable reference for future clinical care.