協助一位重度燒燙傷個案返家之護理經驗

Nursing Experience of Care A Patient with Severe Burns Returned Home

本文旨在描述一位66歲男性因意外導致重度燒燙傷個案之護理經驗，個案於住院治療過程中須每日經歷換藥導致的劇烈疼痛，與反覆清創及植皮手術等醫療處置，後續因傷口疤痕產生導致活動受限，並面臨長期復健的漫長之路。護理期間為2021年6月11日至7月17日，筆者運用Gordon十一項健康評估做為評估架構，確立個案有皮膚完整性受損、疼痛、身體活動功能障礙、焦慮等健康問題。照護期間針對個案的護理問題及需求，提供個別性及獨特的照護計畫，並透過醫療團隊相互合作，使個案快速脫離急性期，教導個案牽張運動及安排漸進式下床和按摩促進疤痕柔軟、運用瑞典式按摩及音樂治療等方法轉移注意力減輕疼痛感，適時提供心理支持緩解個案焦慮；後續照護方面，會診院內出院準備小組協助申請政府長期照護服務、社工團隊透過陽光基金會提供出院後續醫療與輔助，使個案與家屬獲得充足的社會資源，保持正向態度，對復健之路秉持信心，提升自我照顧能力及生活品質。長照資源的介入，使家屬獲得短暫休息的機會，減輕照護者的負擔與心理壓力，期望藉由護理經驗分享，提供相關照護之參考，進而增進臨床照護品質。

This paper presents the author's experience in nursing a male patient aged 66 years who sustained severe burns because of an accident. The case patient experienced severe pain when undergoing mandatory daily dressing, repeated debridement, and skin grafting provided by the hospital. Because of the scars of the wounds, the patient had his activities restricted and was required to undergo long-term rehabilitation. The nursing period was from 2021/6/11 to 2021/7/17,on applying the eleven functional health patterns as described by Marjory Gordon, it was found that the nursing assessment clarified certain nursing issues including impaired skin integrity, pain, physical activity dysfunction and anxiety. The patient was provided with a unique individual care plan according to his medical problems and needs. He left the acute phase instantly through the collaborative efforts between medical teams. A progressive early mobilization program including stretch exercises ,massages to soften the scars, and assisted in getting out of bed. Through Swedish massages and music therapy, he was able to shift his attention away from the pain. The patient also received timely psychological support to alleviate his anxiety. In the follow-up care, a discharge preparation team assisted the patient in applying for governmental long-term care services, and social workers provided him with medical care and assistance following his discharge through the help by Sunshine Foundation. Thus, sufficient social resources were provided to the patient and his family, enabling him to hold a positive attitude and confidence for rehabilitation, improving his self-care ability and quality of life. The intervention that used long-term care resources provided the patient's family with an opportunity for temporary break and mitigated the burden and psychological stress of his care providers. As a result, discussion and sharing of the motivation of nursing experiences with this case in order to provide more information to our profession on caring in such a situation.