照護一位嚴重創傷合併雙下肢截肢個案之護理經驗

A Nursing Experience of a Severe Trauma Case with Bilateral Leg Amputations

陳靜怡(Chin-Yi Chen)；謝春金(Chun-Chin Hsieh)

創傷截肢 ； 焦慮 ； 身體心像紊亂 ； amputation ； anxiety ； body-mental chaos ； trauma

志為護理-慈濟護理雜誌

13卷2期（2014 / 04 / 01）

81 - 90

繁體中文

本文是描述一位44歲女性遭受車禍創傷造成開放性骨折，接受雙下肢截肢之護理經驗。自2012年5月5日至2012年6月20日，運用會談、溝通及觀察等技巧進行資料收集，依個案生理、心理、社會及靈性層面進行整體性評估，顯示個案有急性疼痛、焦慮及身體心像紊亂等健康問題。護理過程中與個案及家屬建立良好的護病關係，提供傷口照護及疼痛護理，運用耐心、傾聽及真誠的陪伴，協助身體照顧及鼓勵表達和宣洩情緒，瞭解個案心中感受，以漸進式引導用手觸摸患肢，讓其能正視截肢部位，並偕同家屬共同參與照護活動，使其能面對身體外觀上的改變重新適應生活。希望藉此護理經驗分享，提供日後臨床照護之參考。

This article described the nursing experience of a 44 year-old woman with bilateral open fractures on lower limbs from car accident and underwent bilateral leg amputations. The nursing period lasted from May 5th to June 20th, 2011. Data were collected through interviews, communications and observations. Overall physical, psychological, social and spiritual conditions were evaluated and the following major health problems were identified: Acute pain, anxiety and body-image disturbance. During the nursing process, the author established a positive relationship with the patient and family, provided appropriate wound care and pain care, and empathized the patient's emotions through patience, listening, honest companion, assisting body care, encouraging expression and emotional output. By encouraging the patient with graduated guidance to touch the amputated legs with her hands, the patient was led to confront the amputated limbs. The family was invited to participate in the nursing activities to aid the patient in re-adapting the physical alterations and return to normal life. The purpose of this article is to provide experience for future nursing care.