運用舒適理論照護一位主動脈剝離術後病人之護理經驗

Nursing Experience of Applying Comfort care a Patient Post Aortic Dissection Operation

10.6647/CN.202112_28(4).0014

謝明珊(Ming-Shan Shieh)；陳慧菁(Hui-Ching Chen)；施孟綾(Meng-Ling Shih)

主動脈剝離 ； 舒適理論 ； 心臟復健運動 ； aortic dissection ； comfort ； cardiac rehabilitation

彰化護理

28卷4期（2021 / 12 / 01）

119 - 132

繁體中文

本文為運用舒適理論照護一位主動脈剝離術後病人之護理經驗。因為主動脈剝離疾病行緊急手術，術後面臨生理不適、擔心病情進展，加上身處陌生且封閉的加護病房環境，產生害怕焦慮不安，引發筆者欲深入探討的動機。主要照護期間為2020年01月02日至01月10日，藉由會談、訪視、觀察、傾聽、身體評估、直接照護等方式，發現有急性疼痛、低效性呼吸型態、焦慮等問題。運用舒適護理緩解手術傷口疼痛與低效性呼吸型態，提供計劃性之呼吸訓練，協助個案執行心臟復健運動計畫，緩解病人生理上的不舒適，主動關懷、傾聽的治療性溝通與陪伴，會客時間親友的支持、護理治療前予充份解釋，緩解焦慮不安提升自在舒適，並強化個案正向思考及心靈寄託。建議未來可增設雙向視訊裝置、電視或收音機，以轉移注意力並緩解焦慮情緒，藉此個案經驗分享期許未來護理人員在臨床照護上之參考，以提升病人之照護品質。

This article describes the nursing experience of applying comfort care a patient post aortic dissection. The case who had fear and anxiety problems and was in an confined intensive care unit environment after the emergency operation. These problems motivated the authors to explore it. We helped her to solve the physiological and psychological problems with applying comfort care. During the nursing period between January 02 to January 10 in 2020, observations, interviews, conversations, listening, and physical assessment and direct nursing cares were used to gather information and assess the patient, including physical, emotional, intellectual, social, and spiritual well-being. The following health issues were identified: acute pain, breathing pattern, and anxiety. In between the process of nursing case, provided with performing cardiac rehabilitation plan, comfort nursing intervention to improve respiratory pattern, and relieve wound pain. In addition, adjusted meeting time elastically, accompanied by family, fully explain before treatment to reduce anxiety and elevate comfort. Furthermore, we suggest to install two-way video devices, view monitors, video for diverting patients' attention and relieving anxiety. This experience would shed light to be useful information for other nurse staffs caring patient with similar situation in the future.

1. 洪穀崑,陳碧君(2018)。一位接受冠狀動脈繞道手術個案加護護理經驗。領導護理，19(3)，66-79。
   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. 潘容芬,陳春香,湯婉孏(2016)。一位主動脈剝離術後病人之重症護理經驗。志為護理，15(3)，82-91。
   連結：
4. 鄭伊婷,吳佩璇,劉秀華(2020)。降低心臟外科病房傳統開心手術病人中度疼痛以上發生率。榮總護理，37(3)，298-305。
   連結：
5. Alligood, M. R.,Marriner-Tomey, A.(2010).Nursing theorists and their work.Mosby.
6. Apóstolo, J. L. A.,Kolcaba, K.(2009).The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders.Archives of psychiatric nursing,23(6),403-411.
7. Kidanemariam, B. Y.,Elsholz, T.,Simel, L. L.,Tesfamariam, E. H.,Andemeske, Y. M.(2020).Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected national hospitals in asmara, Eritrea.BMC nursing,19(100),1-10.
8. Kolcaba, K. Y.,Kolcaba, R. J.(1991).An analysis of the concept of comfort.Journal of advanced nursing,16(11),1301-1310.
9. Krinsky, R.,Murillo, I.,Johnson, J.(2014).A practical application of Kolcaba’s comfort theory to cardiac patients.Applied nursing research,27(2),147-150.
10. Marra, A.,Ely, E. W.,Pandharipande, P. P.,Patel, M. B.(2017).The ABCDEF bundle in critical care.Critical care clinics,33(2),225-243.
11. Ring, D.(2020).Social and mental health affect comfort after surgery or injury.The journal of bone and joint surgery,102(1),28-31.
12. Stephens, R. S.,Whitman, G. J.(2015).Postoperative critical care of the adult cardiac surgical patient. part I: routine postoperative care.Critical care medicine,43(7),1477-1497.
13. Zochios, V.,Klein, A. A.,Gao, F.(2018).Protective invasive ventilation in cardiac surgery: a systematic review with a focus on acute lung injury in adult cardiac surgical patients.Journal of cardiothoracic and vascular anesthesia,32(4),1922-1936.
14. 李紹榕(2016)。急性主動脈剝離。台北市醫師公會會刊，60(4)，21-27。
15. 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。
16. 張于娟,陳玉如(2017)。以護理人員為主導的實證照護措施於呼吸器脫離之運用。台灣醫學，21(2)，208-217。
17. 許鈞,陳益祥,王水深(2015)。急性主動脈剝離的簡介及治療趨勢。台北市醫師公會會刊，59(2)，31-34。
18. 衛生署福利部（2021，01月29日）．108年國人死因統計結果．取自https://www.mohw.gov.tw/cp4631-54482-1.html