照護一位65歲活體肝臟捐贈者之護理經驗

Experience of Surgical Ward Nurses in Promoting Quality in Post-operative Patient Care of a 65-year-old Living Liver Donor

10.6647/CN.201906_26(2).0012

劉翔婷(Shiang-Ting Liu)；蕭惠祝(Huei-Jhu Siao)

活體肝臟捐贈 ； 焦慮 ； 恐懼 ； Living donor liver transplant ； anxiety ； fear

彰化護理

26卷2期（2019 / 06 / 01）

107 - 119

繁體中文

本篇文章為描述一位65歲中年男性，得知攜手結縭40年妻子因罹患B型肝炎帶原導致末期肝硬化，出現黃疸、腹水、肝性腦病變等症狀且病況危急，急需行肝臟移植手術，兒女併有B型肝炎帶原無法捐贈，而個案已超過60歲合適捐贈之年齡，在肝臟移植小組與個案及子女討論下，個案毅然決定行活體肝臟移植手術。照護期間為2016年10月1日至2016年10月9日。筆者透過直接觀察、會談、傾聽及實際參與照護過程收集資料，並運用羅氏適應模式為評估指引，針對個案生理、心理、靈性及社會層面行整體性評估，發現有焦慮、恐懼及急性疼痛之護理問題。筆者主動提供相關衛教，協助其了解手術過程及可能發生的併發症和照護注意事項，並協助個案與醫師討論其術後治療計畫。透過團隊合作，協助個案渡過術後，解決生理、心理問題恢復其生活品質，完成攜手與妻共度日子的心願。

The purpose of this study was to report the nursing care experiences of a 65-year-old male who underwent live donor partial hepatectomy as a donor. The patient's wife who has suffered from hepatitis B carrier related end-stage liver cirrhosis complicated with jaundice, ascites, and hepatic encephalopathy was in urgent need of liver transplantation. All their children were hepatitis B carriers which contraindicated them from being a donor. With our upper donor age limit being 60 years, after a throughout evaluation by our liver transplantation team and discussions with the patient and family members, the patient decided to undergo living liver donation. The period of nursing care was from October 1, 2016 to October 9, 2016. The author collected data through direct observation, interviews, listening and actual participation in the caring process. The Roy's adaptation model was used as a guide to assess the physical, psychological, spiritual and social aspects of the patient. He was further evaluated to see if the patient suffered from anxiety, fear or post-operative acute pain. Moreover, possible operative complications and care precautions related to surgical procedure were informed in layman's term. We also participated in the bedside rounding and were involved in the postoperative treatment plans with the physicians. Through multidisciplinary teamwork, we were able to assist the patient to overcome not just the postoperative discomforts, but also to solve physiological and psychological issues which further restored the patient's quality of life.

1. 許雅嵐(2015)。活體肝臟捐贈者之術前評估與術後照護。彰化護理，22(1)，8-9。
   連結：
2. 郭瑞萍,翁靜美,陳金玫(2015)。護理人員在術後疼痛照護中的挑戰。領導護理，16(4)，11-20。
   連結：
3. Dunwoody, C. J.,Krenzischek, D. A.,Pasero, C.,Rathmell, J. P.,Polomano, R. C.(2008).Assessment, physiological monitoring, and consequences of inadequately treated acute pain.Pain Management Nursing,9(1 Suppl),S11-S21.
4. Erim, Yesim,Beckmann, Mingo,Kroencke, Sylvia,Sotiropoulos, Georgios C.,Paul, Andreas,Senf, Wolfgang,Schulz, Karl-Heinz(2012).Influence of Kinship on Donors Mental Burden in Living Donor Liver Transplantation.LIVER TRANSPLANTATION.,18,901-906.
5. Lee, S. H.,Jeong, J. S.,Ha, H. S.,No, M. J.,Hong, J. J.,Kwon, J. S.,Lee, S. G.(2005).Decisionrelated factors and attitudes toward donation in living related liver transplantation: Tenyear experience.Transplantation Proceedings,37(2),1081-1084.
6. Lee, S.H.,Lim, K.-C.,Jeon, M.-K.,Kim, I.O.,Jeong, J.S.,Hong, J.J.,Ha, H.S.(2012).Postoperative Pain and Influencing Factors Among Living Liver Donors.Transplant Proc.,44,363-365.
7. Lué, Alberto,Solanas, Estela,Baptista, Pedro,Lorente, Sara,Araiz, Juan J,Garcia-Gil, Agustin,Serrano, M Trinidad(2016).How important is donor age in liver transplantation?.World Journal Gastroenterol,22(21),4966-4976.
8. O'Connor, R.,Parkosewich, J.,Curran, J.,Cartiera, K.,Knobf, MT.(2015).Getting used to being a patient: the postoperative experience of living liver transplant donors.Progress in Transplantation,25(2),153-159.
9. Sinatra, R.(2010).Causes and consequences of inadequate management of acute pain.Pain Medicine,11(12),1859-1871.
10. 吳愛靖,孫國燕(2008)。住院兒童恐懼反應的心理護理。齊魯醫學雜誌，19(6)，547-547。
11. 車先蕙,盧孟良,陳錫中,張尚文,李宇宙(2006)。中文版貝克焦慮量表之信效度。台灣醫學，10(4)，447-454。
12. 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。
13. 徐菀雲,陳筱瑀(2008)。焦慮的概念分析。志為護理，7(3)，65-69。
14. 賴秀昀,蔡甫昌,陳慶餘(2005)。器官移植倫理：活體肝臟捐贈與移植。當代醫學，32(1)，57-61。