一位機械性傷害併手指截肢患者之手術全期護理經驗

The Perioperative Nursing Experience of Taking Care of a Patient with Finger Amputations Resulting from Mechanical Injuries

本文主描述一位26歲男性因工作機械性傷害，導致右手第2至5指骨開放性骨折及壓碎性損傷，行第3及第4指截肢手術、第2及第5指骨釘復位手術之護理經驗。於2015年7月7日至7月21日，藉由觀察、會談與直接觀察等方式蒐集資料，運用Mishel不確定感理論為架構，確立個案手術前期面臨截肢手術相關認知的模糊產生不確定感，手術中存有潛在危險性傷害，後期有恢復正常生活功能的不可預測性相關之不確定感的健康問題。在照護過程中，藉由手術前訪視，利用電腦多媒體介紹手術室環境，說明手術前、後注意事項，適時給予關懷，安排醫師利用圖像解釋手術過程，以降低其不確定感；術中予以加蓋溫棉被、適當保護措施、確實對點器械及注重無菌原則，以防潛在危險性傷害；手術後期提供術後及復健相關資訊，教導自我照顧技巧並協助製作自我的病程記錄，鼓勵表達其內心感受並參與病友團體活動，以減輕其挫折及不確定感，增加正向感受，協助個案早日恢復正常生活，以達到適應狀態。期盼個案照護經驗的分享，能提升臨床相關案例之照護品質。 This article describes the nursing experience for a 26 year old male suffering from work-related mechanical injuries leading to the open fracture of the index, middle, ring, and little fingers on the right hand, with the need to amputate the middle and ring fingers. From July 7^(th) to 21^(st), 2015, through direct observation and conversation, and application of the Mishel uncertainty theory, it was concluded that the patient had a fear of the upcoming amputation surgery, the potential risks of the operation, and the recovery of normal physical functions after the operation allowing for a return to a normal lifestyle. During the caring process, the uncertainty of the patient was successfully reduced through the use of pre-operative interviews, multi-media programs that introduced the environment of operation room, explaining the points for attention before and after the operation, and also explaining the operation procedures. By providing proper protective procedures and strictly obeying the aseptic principle, the potential risks of the operation were then attenuated. After the operation, the patient was provided with abundant information about rehabilitation and self-care skills. The patient was also encouraged to record the process of recovery, to express his own feelings, and to participate in group activities, thus increasing his positivity and helping him ease back into his normal daily life prior to the incident. It is with hope that the article can promote and improve the quality of care in similar cases.

This article describes the nursing experience for a 26 year old male suffering from work-related mechanical injuries leading to the open fracture of the index, middle, ring, and little fingers on the right hand, with the need to amputate the middle and ring fingers. From July 7^(th) to 21^(st), 2015, through direct observation and conversation, and application of the Mishel uncertainty theory, it was concluded that the patient had a fear of the upcoming amputation surgery, the potential risks of the operation, and the recovery of normal physical functions after the operation allowing for a return to a normal lifestyle. During the caring process, the uncertainty of the patient was successfully reduced through the use of pre-operative interviews, multi-media programs that introduced the environment of operation room, explaining the points for attention before and after the operation, and also explaining the operation procedures. By providing proper protective procedures and strictly obeying the aseptic principle, the potential risks of the operation were then attenuated. After the operation, the patient was provided with abundant information about rehabilitation and self-care skills. The patient was also encouraged to record the process of recovery, to express his own feelings, and to participate in group activities, thus increasing his positivity and helping him ease back into his normal daily life prior to the incident. It is with hope that the article can promote and improve the quality of care in similar cases.