運用Swanson關懷理論照護一位胸椎損傷青少年之經驗

Experience in Using Swanson's Caring Theory to Care for an Adolescent with Thoracic Cord Injury

10.6142/VGHN.202012_37(4).0007

張騰方(Teng-Fang Chang)；謝雪貞(Shiue-Jen Shie)；李湘鳳(Hsian-Feng Lee)

脊髓損傷 ； 神經性膀胱 ； Swanson關懷理論 ； spinal cord injury ； neurogenic bladder ； Swanson's caring theory

榮總護理

37卷4期（2020 / 12 / 01）

385 - 392

繁體中文

脊髓損傷常見於年輕族群，隨著醫療科技進步改善疾病預後，但卻無法改變失能狀況，造成心理沮喪、焦慮及憂鬱。本文探討一位青少年因車禍導致胸椎第11節損傷造成下肢癱瘓合併神經性腸道及膀胱、大小便無法控制、對現況及未來感到徬徨之照護經驗，照護期間為2019年4月12日至2019年5月4日，筆者以Gordon十一項健康功能型態為評估工具，藉由觀察、訪談、身體評估與查閱病歷等方式收集資料，確認病人主要健康問題為：反射性尿失禁、身體活動功能障礙及缺乏適應及問題解決能力。藉由多媒體護理指導、3D導尿模型示範及回覆示教等方式進行膀胱功能訓練，使病人可完成自我導尿；鼓勵病人學會自我照顧及活動技巧，強化下肢訓練；運用Swanson關懷理論瞭解並陪伴病人，安排參加脊髓損傷病友活動，減輕病人對未來的不確定感，強化正向態度及信念維持，終使病人能主動積極的運用現有肢體能力重塑自我照顧技能，克服新生活挑戰。

Spinal cord injuries are common in the young. Although advances in medical technology have reduced the mortality rate in patients with spinal cord injury, the rates of physical disability and psychological dysfunction have not improved. This article describes the nursing experience of an adolescent who sustained thoracic cord injury in a car accident. The patient was paralyzed from the waist down and had neurogenic bowel and bladder dysfunction, which caused him concern for the future. Direct nursing care was required from April 12 to May 4, 2019. The author used Gordon's functional health patterns by observing, interviewing, assessing physical examination, and performing chart reviews to evaluate patient health, including reflex incontinence, impaired physical mobility, and ineffective adaptability and coping. Bladder training was performed through multimedia teaching, 3D-printed urinary catheterization simulation model, and replay teaching, to enable the patient to self-catheterize. We recommend learning self-care skills and training to strengthen lower limbs. We strive to exercise empathy and be by the patient's side based on Swanson's caring theory. Moreover, several social events are held for patients with spinal cord injury to reduce their anxiety about the future and to help them to stay positive. The goal is for patients to be able to overcome their physical impairment by using strategies to self-care and be successful in their new life.

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