運用整體力量模式於一位復發周邊動脈阻塞病人之護理經驗

The Nursing Experience of Using Holistic Power Model on a Case With Recurrent Peripheral Arterial Obstruction Disease

10.6530/YYN/201807_12(2).0008

蔡婉薇(Wan-Wei Tsai)；陳玉紛(Yu-Fen Chen)

整體力量 ； 周邊動脈阻塞 ； 無力感 ； Holistic Power Model (HPM) ； peripheral arterial obstruction ； powerlessness

源遠護理

12卷2期（2018 / 07 / 01）

68 - 74

繁體中文

本文探討一位75歲男性病患，罹患周邊動脈阻塞再次復發術後之護理經驗。筆者照護期間運用整體力量模式七個力量來源做為評估指引分析無力感問題之來源，個案主因面對疾病再次復發與身體不適，感到焦慮、憂傷、對未來失去信心等，而產生無力感。透過會談方式、傾聽、身體評估方式收集資料，確定有組織灌流改變、無力感之健康問題。照護過程中與個案建立信任感關係，引導個案表達其感受。並與個案共同討論擬定照護計畫，進而增強個案學習疾病照護與復健動機，使其增強信心與力量，以提升控制感來克服身體功能不適，減輕無力感。希望藉此護理經驗與護理同仁分享，以提供照顧此類個案更完善的協助與照護。

This article discusses a 75-year-old man who experienced recurrent peripheral arterial obstruction disease after an arterial bypass surgery that resulted in physical impairment and seriously impacted his life. The patient felt anxious, depression, loss of confidence, and sense of powerlessness. During the patient's hospitalization, the author applied the core concept of Holistic Power Model (HPM) to assess the patient’s health condition through interviews, listening, and physical assessment. The assessment demonstrated that the patient had altered tissue perfusion and powerlessness problems. A therapeutic relationship between patient and author was established during the working process. Nursing interventions helped the patient understand his feelings of powerlessness, encouraged him to express his feelings, motivated his participation in a rehabilitation program, and improved his confidence to overcome obstacles and powerlessness. The patient regained his power and ability in self-care. It is hoped that this case presentation provides useful guidance to nursing colleagues.

1. 王仁愛,吳怡良,黃玉慧,蔡麗雅,黃正宜(2016)。下肢動脈繞道手術術後之下肢運動訓練介紹。嘉基護理，16(1)，14-23。
   連結：
2. 胡凱欽,洪郁惠,任秀琦(2015)。一位創傷後雙下肢骨折產生無力感個案之護理經驗。亞東學報，35，21-30。
   連結：
3. (2018).ACSM's guideline for exercise testing and prescription.Philadelphia:Wolters Kluwer.
4. Chang, N. T.,Chan, C. L.,Lu, Y. T.,Hsu, J. C.,Hsu, Y. N.,Chu, D.,Yang, N. P.(2013).Invasively-treated incidence of lower extremity peripheral arterial disease and associated factors in Taiwan: 2000-2011 nationwide hospitalized data analysis.BMC Public Health,13(1),1107.
5. George, A. A.,George, S. G.,Stavros, A. A.,Ragai, R. M.,Jonathan, D. S.,Francesco, T.(2017).Bypass surgery for chronic lower limb ischaemia.Cochrane Database Systematic Reviews
6. Lane, R.,Harwood A.,Watson, L.,Leng, G. C.(2017).Exercise for intermittent claudication.Cochrane Database Systematic Reviews
7. Lewis, L.(Ed.),Dirksen, S. R.(Ed.),Heitkemper, M. M.(Ed.),Bucher, L.(Ed.),Camera, I. M.(Ed.)(2014).Medical-Surgical Nursing: Assessment and management of clinical problems.St. Louis, MO:Elsevier Mosby.
8. Miller, J. F.(Ed.)(2000).Coping with chronic illness: Overcoming powerlessness.Philadelphia, PA:F. A. Davis.
9. Rose, M. D.(2015).A review of peripheral arterial disease (PAD).British Journal of Cardiac Nursing,10(6),277-283.
10. Tompra, N.,Foster, C.,Sanchis-Gomar, F.,De Koning, J. J.,Lucia, A.,Emanuele, E.(2015).Upper versus lower limb exercise training in patients with intermittent claudication: A systematic review.Atherosclerosis,239(2),599-606.
11. William, R. H.,Ehrin, J. A.,Christopher J. L.,Eric, P. B.(2015).Pathogenesis of the limb manifestations and exercise limitations in peripheral artery disease.Circulation Research,116(9),1527-1539.
12. 林文玓,顏啟華(2015)。周邊動脈疾病。家庭醫學與基層醫療，30(2)，49-58。
13. 林思吟,蔡碧雀(2013)。運用羅氏適應模式照顧一位心臟移植術後無力感病人的護理經驗。志為護理，12(6)，98-107。
14. 胡月娟（校閱）(2013).內外科護理學.台北:永大.