照顧一位喪偶截肢個案渡過哀傷過程之護理經驗

The Experience of Nursing Care Given to An Amputation Patient During the Grief-Phase

本個案報告主要是探討一位喪偶又因糖尿病足進行截肢手術的照護經驗，發現個案因喪偶後失去自我生活能力所引發一連串生理狀況失序，再加上截肢的雙重打擊下，同時面臨喪偶之苦及肢體失落之痛，使得個案失去生存意念，表現出自我放棄治療及自傷的行為。護理期間為2012/2/2至2/22經由直接護理、身體評估、會談等方式收集資料，運用Gordon十一項功能性健康型態進行評估，發現個案主要問題有哀傷功能失常／喪偶後情緒無抒發管道、家庭因應能力失調：妥協性／因親人死亡家庭成員互動不佳、治療計畫處置能力增進的準備度／因原主要照顧者死亡。在照護初期啟動自傷防治，運用同理心協助喪偶哀傷處置，對截肢重新詮釋，找到活下去的意義促進自我照護能力，過程中主動關懷、真誠傾聽，與個案及家屬建立良好護病關係，讓彼此體會哀傷反應，引導家屬共同參與照護活動，建立新的主要照顧者。希望藉此經驗可提供護理人員照護喪親的個案，協助渡過哀傷過程，以及了解截肢個案個別性，提供獨特的護理計畫。

This patient report explores the care given to a widowed man with foot amputations due to diabetes. After his wife died,he lost self-care ability result in disorder of physical condition. In addition to facing his suffering, he had to accept how the amputation had made him lose of living capacity and showed to give up treatment and self-injury behavior. The author cared for the patient from February 2nd to 22nd 2012, collecting information through direct care, physical assessments, and conversations, etc. Gordon’s 11 functional health patterns were used to evaluate the patient and found out major problems were sadness,family support were not goot enough,and invalidity health care plan. In the early care period, to prevent patient’s self-injury, the author used empathy therapy to assist the widower during his grief-phase, reinterpreted amputation, and helped him find a way to live with promoted self-care abilities. During the active care period, the author endeavored, in good faith, to listen and to establish good relations with the intensive care patient and his family,allowing each family member to experience their reaction with grief-phase , guiding them to participate in care activities, and establishing a new primary caregiver. The author hope is to provide nursing care experience of bereavement cases, helping patients to overcome the grief process, and to understand individual amputation cases, providing a unique care plan.