照護一位青少年行尿道下裂手術之護理經驗

The Postoperative Nursing Care Experience of an Adolescent with Hypospadias

本文描述一位青少年行尿道下裂手術面臨傷口疼痛及生殖器外觀改變產生身體心像紊亂之照護過程。個案因陰莖型尿道下裂於青少年期再次接受手術治療，術後面臨傷口疼痛不適、生殖器外觀改變、擔心回學校同儕對自己的觀感及害怕與他人的不同，導致心情低落、沮喪，引發筆者欲深入探討的動機。照護期間自2018年7月17日至7月22日，經由直接觀察照護、會談等方式收集資料，運用Gordon十一項健康功能型態進行整體性評估，確立有「組織完整性受損」、「急性疼痛」、「身體心像紊亂」三項護理問題。透過指導深呼吸轉移注意力，改善傷口疼痛不適，謹慎評估傷口部位，教導傷口照護的方式，藉由會談及BAS-2評估量表，了解個案對生殖器外觀改變之感受，耐心回應個案照護相關疑問及提供過去照護經驗等成功資訊，提升個案的自信心、接納自我。經由此次護理經驗，建議醫院能建立合適的身體外觀評估量表，提供護理人員作為客觀的評估工具，更能達到連續性、完整性照護。希望以此經驗分享提供相關人員日後臨床照護之參考。

"The article described the nursing experience of an adolescent who had an operation of Hypospadias, suffered from pain and body image disturbance as a result of body appearance change. The patient underwent the reconstruction again because of penile hypospadias in the state of adolescence. The patient’s frustration and depression were due to wound pain, body appearance change, and anxiety from his peers’attitude and he was afraid of being different to others, which motivated the July 17 to JULY 22, 2018. Based on Gordon 11 functional health assessment, the adolescent was identified as having three nursing problem: impaired tissue integrity, acute pain, and disturbed body image. To address these issues, the following interventions were implemented: nursing instructions for deep breathing to draw attention away from pain, pain relief, careful wound assessment, and wound care. To feel sympathy to the patience with body appearance change, replied the related questions and referred successful cade sharing experience with patience in order to boost the patient’s confidence and re-established selfacceptance by means of interview and BAS-2. Through this nursing experience, it was suggested that the hospital should establish proper physical examination form as an objective evaluation method for nursing personnel to achieve the continuity and total care. The nursing experience from this cade report could be a reference to nursing personnel in clinic care."