運用Swanson關懷理論於意外創傷導致左下肢截肢病人之護理經驗

Nursing Experience of Patients with Left Lower Extremity Amputation Caused by Accidental Trauma from Application of Swanson Care Theory

10.29494/LN.202303_24(1).0007

曾盈慈(Ying-Tzu Tseng)；王芊蕙(Chien-Hui Wang)；羅美芳(Meei-Fang Lou)

Swanson關懷理論 ； 意外創傷 ； 截肢 ； Swanson caring theory ； accidental trauma ； amputation

領導護理

24卷1期（2023 / 03 / 01）

81 - 95

繁體中文;英文

本篇描述一位中年男性，原有中風致右側肢體偏癱病史，經復健已可徒手行走和生活部份自理，此次因遭交通意外致左膝下截肢及多處骨折，使個案面臨肢體移除造成身、心功能障礙等問題，護理過程自2019年5月3日至5月30日，進行整體性護理評估，確認主要的健康問題為疼痛、身體活動功能障礙、無望感。護理過程運用Swanson關懷理論，給予積極關懷及正向支持，提供伊甸八德中途致障者心情俱樂部資訊，尋求支持團體力量，教導個案每日數次由左腳膕窩到殘肢末端按摩及輕拍10分鐘，以緩解幻肢痛不適；以及執行漸進式活動，每日2～3次由照顧者輕度扶持下轉位至特製輪椅上，並設計復健活動功課表供出院後使用，以增進身體活動功能；另參考個案過去面對壓力因應方式，與其共同回顧三年前面對中風事件衝擊時之因應技巧，自我激勵達成堅持不懈、懷抱希望且積極復健，並將經驗應用於此次意外事件。經由本次照護經驗，建議臨床護理師照護此類復健需求個案時，可運用「Swanson關懷理論」評估病人需求，提供病人合適照護計畫與措施，整合相關醫療團隊以提升復健動機與照護品質。

This article describes a middle-aged man with a history of hemiplegia of the right limb caused by a stroke. After rehabilitation, he was able to walk on his hands and take care of himself. This time, he was amputated below the left knee and had multiple fractures due to a traffic accident, which made the case facing problems of physical and mental dysfunction caused by the removal of limbs. The nursing process covers from May 3 to May 30, 2019, a holistic nursing assessment was conducted to confirm that the main health problems include pain, physical activity dysfunction, and hopelessness. The nursing process applies Swanson's caring theory to provide active care and positive support, provide information about Eden Bade, the club that look after the frame of mind for sudden disabled people; seek the strength from groups support, and teach patients to massage from the left foot popliteal to the end of the residual limb several times a day and pat for 10 minutes to relieve the discomfort of phantom limb pain; and perform progressive activities, 2-3 times a day with light support from the caregiver to transfer to a special wheelchair, and design a rehabilitation activity schedule to use after discharge, in order to improve function of physical movement; also refer to the past stress coping methods of the case, review the coping skills together when faced with the impact of the stroke episode three years ago, self-motivate to achieve perseverance, active rehabilitation with hope, and apply the experience to this accident. Based on this nursing experience, it is recommended that the clinical nurses can apply the "Swanson Care Theory" to assess patients' needs when caring for such cases of rehabilitation requirement; provide patients with appropriate care plans and measures, and hence integrate relevant medical teams to improve motivation for rehabilitation as well as care quality.

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