照護一位頭部創傷病人之護理經驗

A Nursing Experience of Caring for a Patient with Head Injury

10.29494/LN.201609_17(3).0005

劉于甄(Yu-Chen Liu)；方雅晶(Ya-Ching Fang)；林姿佳(Tzu-Chia Lin)

頭部創傷 ； 疼痛 ； 身體心像改變 ； 照顧者角色緊張 ； head injury ； pain ； body image disturbance ； caregiver role strain

領導護理

17卷3期（2016 / 09 / 01）

45 - 58

繁體中文

2014年死傷之交通事故，造成415,048人傷亡，頭部創傷易導致毀容、失能、死亡，帶給病人及家屬諸多不適和不便，因而引發筆者探討動機，本文敘述一名45歲男性車禍頭部創傷之照護經驗，護理期間自2014年9月17日至9月22日，筆者運用整體性護理評估，以觀察、會談、傾聽、身體評估等技巧收集其生、心、靈、社會資料，確立個案有手術後疼痛及身體心像改變等健康問題，案妻因擔心個案手術預後，而有照顧者角色緊張的護理問題。照護期間筆者教導個案深呼吸技巧，並使用薰衣草精油及播放個案喜愛的音樂，緩解個案疼痛，同時發揮同理心給予鼓勵、支持，運用電子產品及網路，重建個案身體心像、回饋社會，提供案妻個案資訊及相關護理指導，並叮嚀案妻注意自身健康與教導放鬆技巧，改善案妻照顧者角色緊張的問題，協助個案及案妻面對此次突發意外事件的身、心衝擊，以回歸日常生活。臨床鮮少有放鬆療法的衛教單張或影片，建議臨床可多元製作放鬆療法衛教手冊及影片，提升病人及家屬的心理支持和照護品質，以達到身心平衡。

In 2014, there were an estimated 415,048 injuries or deaths secondary to traffic accidents. Disfigurement, disability and even death due to head injury result in patients' suffering and inconvenience in daily life activities, as well as family members' burden. This article describes a nursing experience of caring for a forty-five year-old male with head injury secondary to a motor vehicle accident. The nursing period was from September 17 to 22, 2014. With integral nursing assessment, the author collected the patient's information regarding psycho-social-spiritual needs through observation, interviews, listening, and physical examination. The nursing problems the patient encountered were postoperative pain and change in body image. The patient's wife, as a caregiver, was worried about the patient's progress after surgery and suffered from role tension. During the care period, the author taught the patient about deep breathing techniques, aromatherapy and playing soothing music for relaxation and relief of pain. With electronic products and website programs, the author encouraged and supported the patient with an emphasis on rebuilding the patient's body image before returning to society. The author offered the patient's wife head injury-relevant information and care guidelines of caregiver self-care and relaxation skills, as well as assisting them in coping with the encountered impacts of the incident so that they could be able to return to daily life. Since few teaching materials or videos are available regarding proper relaxation technique, the author suggested producing more relevant handouts and videos to promote the patient and family's emotional support and ability to achieve body-mind balance.

1. 程馨蕙,董志明,蔡新茂,黃戊田(2014)。薰衣草精油與音樂療法對人體之紓壓成效薰衣草與音樂之紓壓。美容科技學刊，11(1)，25-40。
   連結：
2. Fang, L.,Hung, C. H.,Wu, S. L.,Fang, S. H.,Stocker, J.(2012).The effects of cryotherapy in relieving postarthroscopy pain.Jouanal of Clinical Nursing,21(5-6),636-643.
3. Hansen, M. S.,Bernnum, J.,Moltke, F. B.,Dahl, J. B.(2011).Pain treatment after craniotomy: where is the (procedure-specific) evidence? A qualitative systematic review.European Journal of Anaesthesiology,28(12),821-829.
4. Lin, P. C.(2012).An evaluation of the effectiveness of relaxation therapy for patients receiving joint replacement surgery.Jouanal of Clinical Nursing,21(5-6),601-608.
5. 內政部警政署 ( 2015 , 4 月 16 日 ) . 道路交通事故原因 、 傷亡．取自http://www.npa.gov.tw/N PAGIP/wSite/ct?xItem369473&ctNode=1259 5&mp=1
6. 明金蓮,洪曉佩(2011)。急性疼痛評估與症狀護理。源遠護理，5(1)，11-16。
7. 唐秀燕,梁蕙芳(2010)。運用 Watson 理論於一位頭部外傷病患及其主要照顧者之護理經驗。志爲護理 - 慈濟護理雜誌，9(4)，119-128。
8. 許家華,紀慧眞,蔡明修,李彩緣(2012)。一位接受多次手術後口腔癌患者之護理經驗。若瑟醫護雜誌，6(1)，130-140。
9. 楊明磊(2011)。按摩的心理影響與心理治療效用。諮商與輔導，305，10-15。
10. 蕭如宜,王蓉敏(2012)。重建腦中風病患身體心像之護理經驗。志爲護理 - 慈濟護理雜誌，11(3)，87-98。
11. 龔宥潔,柯薰貴(2014)。一位因車禍致脊髓損傷患者之照護經驗。志爲護理 - 慈濟護理雜誌，13(1)，101-110。

1. 葉美延,陳鈺潔,徐珮瑀(2023)。照顧一位腦瘤術後個案之護理經驗。領導護理，24(1)，52-65。