運用Watson關懷理論於一位塵爆燒燙傷病人之護理經驗

Nursing Experience with One Scald Burn Patient of Dust Explosion by Watson's Caring Theory

10.6647/CN.201809_25(3).0010

洪誼婷(Yi-Ting Hung)；林心怡(Hsin-Yi Lin)

燒燙傷 ； 身體活動功能障礙 ； 潛在危險性創傷症候群 ； scald burns ； physical activity dysfunction ； potential dangerous traumatic disorder

彰化護理

25卷3期（2018 / 09 / 01）

67 - 80

繁體中文

大面積燒傷是一嚴重創傷且具生命威脅，初期需要積極醫療處置以維持生命，接續所要面對的而是長時間的復健，此過程中會面臨許多挑戰。本文敘述一位歷經八仙塵爆事件燒燙傷病人之護理經驗，身上多處二到三度燒燙傷，TBSA高達61%，個案經歷了生死關頭及身體傷痛，心中的恐懼與害怕難以抹滅，因此筆者於2015年8月10日至2015年10月9日之護理期間運用整體性評估收集資料，確立個案護理問題為：急性疼痛、身體活動功能障礙、潛在危險性創傷後症候群。筆者運用Watson十項關懷照護理論，以人性關懷為護理服務的核心，並結合Levinas、Logstrup及Rumi三位哲學家觀點，以此理念在護理中實踐，針對問題擬定護理計畫，給予個別性護理措施。看著個案經歷了八仙塵爆事件，從急性期傷口劇烈疼痛及參雜許多負向情緒到接納自己外觀改變，並且用正向樂觀態度勇敢面對，個案這一路上的轉變，從中見證及學習了生命的韌性，筆者也與個案一同成長，期望能藉由此照顧經驗分享，提供臨床照護上之參考。

Extensive burn is a kind of severe trauma and it threatens life. At early stage, it requires constructive medical treatment to maintain life. Subsequently, there will be long-term rehabilitation and significant challenge in the process. This study describes the nursing experience with one patient of scald burns in Dust Explosion Incident at Formosa Fun Coast Water Parks. The patient had partial-thickness and three-degree scald burns on the body and TBSA was high as 61%. The case experienced the crisis of life and physical pains and the fear was permanent. Thus, during the nursing process from August 10 to October 9, 2015, the author collected data by overall evaluation and validated the case's nursing problem below: acute pain, physical activity dysfunction and potential dangerous traumatic disorder. The author applied Watson's Caring Theory often cares and treated human concern as the core of nursing service. This study combined perspectives of three philosophers Levinas, Logstrup, and Rumi and practiced the concept in nursing. The author established nursing plan regarding the problems and provided individual nursing measures. The case experienced Dust Explosion Incident at Formosa Fun Coast Water Park, changed from severe pain of wounds at acute period, negative emotion to acceptance of the appearance with positive and optimistic attitude. In the process, the case witnessed and learned the toughness of life. The author grew with the case and intended to share this caring experience as the reference of clinical care.

1. 陳生松(2016)。我是職能治療師，燒傷復健路上我陪你。護理雜誌，63(1)，42-48。
   連結：
2. 溫慧敏(2016)。迎向生命的曙光─淺談八仙塵爆事件。護理雜誌，63(1)，17-21。
   連結：
3. Gullick, J. G.,Taggart, S. B.,Johnston, R. A.,Ko, N.(2014).The trauma bubble: patient and family experience of serious burn injury.Journal of Burn Care & Research,35(6),e413-e427.
4. Kagan, R. J.,Peck, M. D.,Ahrenholz, D. H.,Hickerson, W. L.,Korentager, R.,Kotoski, G.(2013).Surgical management of the burn wound and use of skin substitutes: an expert panel white paper.Journal of Burn Care & Research,34(2),e60-e79.
5. Kornhaber, R.,Wilson, A.,Abu-Qamar, M. Z.,McLean, L.(2014).Adult burn survivors' personal experiences of rehabilitation: an integrative review.Burns,40(1),17-29.
6. Osler, T.,Glance, L. G.,Hosmer, D. W.(2010).Simplified estimates of the probability of death afer burn injuries: extending and updating the Baux score.Journal of Trauma and Acute Care Surgery,68(3),690-697.
7. Park, E.,Oh, H.,Kim, T.(2013).The effects of relaxation breathing on procedural pain and anxiety during burn care.Burns,39(6),1101-1106.
8. Watson, J.(1990).Caring knowledge and informed moral passion.Advances in Nursing Science,13(1),15-24.
9. Watson, J.(2003).Love and caring: Ethics of face and hand-An invitation to return to the heart and soul of nursing and our deep humanity.Nursing administration quarterly,27(3),197-202.
10. 王惠美,趙慧玲,黃薇瑄,廖婉君,胡曉珍,陳德芳,于博芮(2014)。一般外科病患術後傷口換藥疼痛改善專案。領導護理，15(3)，96-107。
11. 吳佳儀,李明濱,吳其炘(2015)。燒傷之身心問題與全人照護。台灣醫界，58(8)，9-14。
12. 張哲瑋,黃慧夫,劉昌杰,柯安達,莊樹揚,吳俞鋒,戴浩志(2017)。八仙塵爆的治療花費分析－臺大醫院燒燙傷中心經驗。臺灣整形外科醫學會雞誌，26(1)，99-108。
13. 許華真,陳淑芳,徐琬茵,謝生蘭(2017)。一位因石化氣爆燙傷病人之加護護理經驗。高雄護理雜誌，34(1)，61-71。
14. 衛生福利部中央健康保險署(2016).八仙粉塵暴燃事件發生週年,醫療照護情形說明．取自http:// www.nhi.gov.tw/News_Content.aspx?n=FC05EB85 BD57C709&sms=587F1A3D9A03E2AD&s=ED8E 36DA878A4076

1. 葉淑玲,許晴惠,紀夙芬,王惠萍(2023)。照顧一位正顎手術後個案之護理經驗。新臺北護理期刊，25(2)，140-148。
2. 袁鈺涵(2022)。照護一位意外燒傷患者之護理經驗。志為護理-慈濟護理雜誌，21(4)，97-106。