運用轉銜理論協助罹患先天性複雜型腹裂嬰兒家庭之護理經驗

Nursing Experience Applying Transition Theory to Assist the Family of an Infant With Complex Congenital Gastroschisis

10.6224/JN.202408_71(4).13

楊子瑩(Tzu-Ying YANG)；錢佳慧(Chia-Hui CHIEN)；劉又瑛(Yu-Ying LIU)；蔡劭瑜(Shao-Yu TSAI)

轉銜理論 ； 先天性複雜型腹裂 ； 嬰兒 ； 家庭 ； transition theory ； complex congenital gastroschisis ； infant ； family

護理雜誌

71卷4期（2024 / 08 / 01）

104 - 111

繁體中文;英文

本文描述運用轉銜理論（Transition Theory）協助家庭走過先天性複雜型腹裂嬰兒疾病歷程的護理經驗。護理期間自2023年3月3日至2023年5月9日，涵蓋住院至出院後的照護。筆者以轉銜理論作為照護指引，透過身體評估、觀察及會談等方式收集資料，確立主要健康問題為「家庭運作過程增進的準備度／個案先天性疾病與複雜照護需求，家庭因應疾病的多變與照護的調適」，並將護理過程歸納為三個時期，分別為家庭面對孩子先天性疾病之（一）不確定感的調適期，（二）照顧者角色的承擔期，（三）角色成長與家庭的再連結期。筆者在每個時期為家庭制定目標並提供相應措施，如第一期引導家庭表達擔憂，提供個別化衛教與心理支持，以理解個案疾病歷程，緩解焦慮迷茫；第二期提供睡眠指導及客製化居家照護日程表，增進因應技巧與角色功能發展；第三期鼓勵家庭於個案成長過程探索生命價值，以達靈性層面的滿足及加深家庭關係之連結。最終，家庭增強照護信心和能力，對未來充滿樂觀與期待，順利適應個案返家後生活。當家庭面對孩子罹患先天性疾病時，常陷入自我懷疑的困境，並面臨連續複雜的關卡。護理人員運用轉銜理論能全面深入和應對個案及家庭在轉變中的需求，有助更完善地評估、規劃和照護，從而提升家庭能力並成功走過充滿挑戰的轉銜之路。

This article describes the application of transition theory to assist a family with an infant with congenital complex gastroschisis. The nursing period, from March 3, 2023 to May 9, 2023, encompassed care from hospitalization to discharge. The author employed transition theory as a guide and used physical assessments, observations, and interviews for data collection as well as behavioral processes records. The primary nursing problem was identified as "preparation for family operation process enhancement/child's congenital disease and complex care needs, and the family's response to the challenges of the disease and care adaptation." The three phases of nursing care were summarized as: (1) the family adjustment to uncertainty, (2) undertaking caregiving roles and responsibilities, and (3) role development and family reconnection. The author established specific goals for each phase and provided corresponding interventions for the family. In the first phase, the author guided the family in expressing their concerns, and offered personalized health education information as well as psychological support to help them understand the progression of their child's disease and alleviate related anxiety and confusion. In the second phase, the author offered sleep guidance and customized home care schedules to support coping skill development and role functioning. In the third phase, the family was encouraged to explore the meaning of life while accompanying their child's growth in order to achieve spiritual growth and deepen the reconnection within the family. Ultimately, the family strengthened their confidence and capabilities in caregiving and embraced optimism and expectations for the future, enabling them to adapt smoothly to life after their child's return home. When families are confronted with their child's diagnosis with a congenital disease, they often find themselves in a state of self-doubt and faced with continuous challenges. Nurses may employ transition theory throughout the nursing process to better understand and address the evolving needs of both children and their families during the transition phase. Furthermore, transition theory may be applied to help nurses better assess, plan, and care for their patients, which can enhance the capabilities of families and facilitate their successful navigation through the challenging transition journey.

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