運用關懷理論照護一位因車禍導致低位頸椎損傷合併急性四肢癱瘓術後個案之護理經驗

Nursing experience of a postoperative patient with lower cervical spinal injury and acute quadriplegia due to car accident by Watson's Caring Theory

本篇報告為描述照護一位33歲男性，因車禍導致第5-7頸椎損傷而接受頸椎減壓融合固定術之護理經驗。護理期間為2014年8月12日至2014年8月31日。筆者運用Gordon十一項健康功能型態為評估架構，並以身體評估、觀察、會談及直接照護等方式完成資料整理。經評估分析後，發現個案之健康問題包括：（一）急性疼痛：與頸椎減壓融合固定術造成組織受損有關；（二）自我照顧功能缺失（進食、梳洗、沐浴、如廁）：與頸椎損傷致四肢乏力，無法執行日常功能有關；（三）無望感：與擔心肢體殘障無法復原，成為家人負擔有關等三個健康問題。經由教導個案冰敷患部減輕腫脹、並示教肌肉放鬆技巧；設計復健運動促進肌力改善，運用輔具強化肢體剩餘功能；以Watson關懷照護理論透過主動關懷，幫助個案提升自我照護能力介入後。結果個案傷口疼痛指數由9分降為3分；並能手握湯匙進食、洗臉，且以四腳助行器獨立行走完成如廁、沐浴等自我照顧功能；能獨立完成部份日常活動，使其對未來產生希望與信心，能主動表達正向自我感受，積極配合復健活動。

This report describes the nursing experience of a 33-year-old male suffered from 5th to 7th cervical spinal injury due to car accident and received cervical decompression and fusion fixation treatment. The nursing period was from August 12th to August 31th in 2014. The author utilized Gordon Eleven Functional Health Patterns as the assessment structure along with body assessment, observation, interview and nursing care to collect data and several health problems had been discovered :(a) Acute pain due to tissue damage caused by cervical decompression and fusion fixation; (b) Self-care deficits (eating, washing and dressing, bathing, toileting) was associated with limbs weakness caused by cervical spinal injury, and did not being able to perform daily task; (c) Hopelessness was associated with worrying about physical disability, and becoming a burden to the family.. After the intervention of teaching patient how to use ice compress on affected area to alleviate swelling, demonstrating muscle relaxation techniques, designing rehabilitation exercise to improve muscle strength, using auxiliarγ equipments to strengthen the remaining function of limbs, and applying active caring to enhance one's self-care ability according to Watson's caring theory, the patient's pain score decreases from 9 points to 3 points. The patient could grip a spoon to eat, wash face, and perform toileting, batching and other self-care activities independently. Being able to complete some of the daily tasks independently have made the patient generate hope and confidence to the future. This nursing experience based upon caring theory enables the patient to express positive feelings initiatively and cooperate on rehabilitation activities actively.