運用不確定感理論於一位初次自發性氣胸病人之急診照護經驗

Applying Mishel's Uncertainty Theory in Caring a First-time Spontaneous Pneumothorax Patient in Emergency Department: A Case Report

10.6530/YYN.201907_13(2).0008

陳虹如(Hung-Ju Chen)；李小萍(Hsiao-Ping Li)；陳美容(Mei-Jung Chen)

不確定感理論 ； 自發性氣胸 ； 急診 ； uncertainty theory ； spontaneous pneumothorax ； emergency department

源遠護理

13卷2期（2019 / 07 / 01）

55 - 61

繁體中文

本文描述一位因背痛、呼吸不順獨自到急診就醫，診斷為初次自發性氣胸男性個案之照護經驗，因個案氣胸範圍大需立即放置胸管，面對突發的狀況與緊急治療過程，且對環境、疾病症狀不熟悉產生不確定感而拒絕配合緊急治療，但若延誤可能會因此危及生命。照護期間為106年4月28日16：37至19：55，運用Mishel不確定感理論為評估架構，透過直接照護、觀察、會談、病歷查閱等方式收集資料，確立個案有不確定感之護理問題，透過傾聽、關懷、心理支持、資訊網路輔助與詳細解釋，提供專業護理指導介紹疾病內容、治療過程及方向，降低個案的不確定感，並配合醫師治療放置胸管。在忙碌的急診工作環境中，容易忽略病人心理問題情況，如何與病人建立良好護病關係，運用個別性的護理指導，以提供病人完整身、心、靈照護，掌握治療的關鍵時刻是刻不容緩的，藉由此篇報告，期望能提供急診護理師對照護自發性氣胸病人之參考。

This case report describes the nursing care experience of a first-time spontaneous tension pneumothorax adult in the emergency department (ED). The patient experienced this unexpected situation of backache and dyspnea when he was alone. The patient expressed tension, anxiety and immense uncertainty and rejection toward medical procedures in the ED. The caring period was from 16:35 to 19:55. Data were collected by direct patient care, observation, conversation and medical records. Approaches to the patient's rejection toward treatment used the assessment framework of Mishel's uncertainty theory and provided appropriate nursing care with education, therapies, and procedures to reduce pneumothorax. Use was made of empathic listening, interactive dialogue, mental health support, reference to internet information, and address of the patient's concerns and anxieties. The relief of the uncertainties helped to gain patient's cooperation during chest tube insertion. The ED atmosphere tends to disregard a patient's mental needs. In this case of a patient with pneumothorax, it was not only to stabilize patient's vital signs but to relieve underline anxieties. This report addresses individual care needs to provide pertinent physiology, psychological and spiritual care.

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