運用羅氏適應理論照護一位慢性阻塞性肺疾病病人之護理經驗

Applying Roy's Adaptation Theory to Care a Patient with Chronic Obstructive Pulmonary Disease

10.6386/CGN.202006_31(2).0010

謝秉倍(Ping-Pei Hsieh)；高玉音(Yu-Yin Kao)；李淑姬(Shu-Chi Li)；唐玉香(Yu-Hsiang Tang)

慢性阻塞性肺疾病 ； 低效性呼吸型態 ； 無力感 ； chronic obstructive pulmonary disease ； ineffective breathing pattern ； powerlessness

長庚護理

31卷2期（2020 / 06 / 01）

253 - 263

繁體中文

本文探討一位慢性阻塞性肺疾病病人因疾病反覆發作入院求治的護理經驗，筆者於2016年11月26日至2017年1月7日期間運用羅式適應模式及透過觀察、直接照護、病歷查閱、身體評估與會談收集資料，歸納出有低效性呼吸型態、營養不均衡：少於身體所需及無力感之主要健康問題。照護期間教導個案胸腔復原運動，改善呼吸困難症狀；依照個案喜好多吃少餐，採高熱量高蛋白飲食，維持身體基本代謝需求；觀察個案語言及非語言行為，透過主動關懷、陪伴，建立信任感。透過與個案家人討論護理計劃並鼓勵更多的家庭成員支持和鼓勵，幫助個案與訪客互動，並鼓勵個案建立自尊心。進而達成減少再入院率與提昇良好生活品質，這次護理經驗可以使護理專業人員受益，強調自我照護和家人參與的重要性，並為護理人員將來護理相似患者提供參考。

This report described the nursing experience of applying Roy's adaptation theory to care a patient with chronic obstructive pulmonary disease. The caring period was between November 26th 2016 and January 7th 2017. Data collection was performed through direct caregiving, observation, interviews, physical assessment, and chart review. The major health problems identified included ineffective breathing pattern, imbalanced nutrition (less than body requirements), and powerlessness. Through nursing care interventions, the author provided lung rehabilitation training to improve shortness of breath. According to the patient’s preference, we provided more frequent and smaller meals with and high calorie and high protein to maintain nutrition needs. By direct- caring, listening, and accompany, we established trust with the patient. By discussing care plans with the patient's family members, we encouraged family members express their supports to help the patient interact with visitors and develop his self-esteem. The caring goals were to decrease the risk of readmission and promote his quality of life. This nursing experience emphasized the importance of self-care and family participation and provided nursing staff with a reference for caring similar patient in the future.

1. Emme, C.,Rydahl Hansen, S.,Ostergaard, B.,Schou, L.,Svarre Jakobsen, A.,Phanareth, K.(2014).How virtual admission affects coping – telemedicine for patients with chronic obstructive pulmonary disease.Journal of Clinical Nursing,23(9-10),1445-1458.
2. Park, S. K.,Richardson, C. R.,Holleman, R. G.,Larson, J. L.(2013).Frailty in people with COPD, using the national health and nutrition evaluation survey dataset (2003–2006).Heart & Lung: The journal of acute and critical care,42(3),163-170.
3. Snider, J. T.,Jena, A. B.,Linthicum, M. T.,Hegazi, R. A.,Partridge, J. S.,LaVallee, C.,Wischmeyer, P. E.(2015).Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among medicare patients with COPD.Chest Journal,147(6),1477-1484.
4. 呂沛晴, P. C.,戴美玲, M. L.(2010)。一位慢性阻塞性肺疾病個案無力感之護理經驗。澄清醫護管理雜誌，6(4)，39-45。
5. 郭信芳, H. F.,王淑蕙, S. H.(2013)。運用肺部復健照護一位慢性阻塞性肺疾病患者之經驗。新臺北護理期刊，15(2)，123-132。
6. 陳乃釧, N. C.,蘇千玲, C. L.,彭雪雲, H. Y.,沈建業(2009)。慢性阻塞性肺疾病患者之飲食營養。台灣呼吸治療雜誌，8(1)，63-74。
7. 陳綱華, K. H.,葉淑玲, S. L.,王婉璇, W. S(2013)。慢性阻塞性肺疾病患者居家自我管理需求與醫療照護者角色。長庚護理，24(1)，32-40。
8. 陳慧雯, H. W.,李雅欣, Y. H.,王桂芸, K. Y.(2011)。慢性阻塞性肺疾病個案「低效性呼吸型態」之護理。護理雜誌，58(5)，95-100。
9. 廖敏季, M. C.,邱靜娥, J. E.,簡榮彥, J. Y.,蔡志欣, C. H.(2013)。復健運用於長期呼吸器依賴病人之成效。台灣醫學，17(5)，468-475。
10. 蔡雨涵, Y. H.,陳玉如, Y. J.(2013)。慢性阻塞性肺病者之自我管理。台灣醫學，17(2)，195-201。
11. 衛生福利部中央健康保險署 ( 2016，6 月 6 日 ) ．國人全民健康保險就醫疾病資訊．取自 http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1023&webdata_id=805 [Bureau of National Health Insurance, Taiwan, ROC. (2016). National people's health insurance medical disease information. Retrieved from http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1023&webdata_id=805]
12. 衛生福利部統計處 (2016，8 月 5 日 )．104 年國人死因統計結果分析．取自 http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&fod_list_no=6201[Ministry of Health and Welfare National Statistics, R.O.C. (2016). Vital statistics the main cause of death statistics. Retrieved from http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&fod_list_no=6201]