88 Wound Care Pain Weinberg 2000 Briggs et al., 2003 Ersek & Poe, 2004 Briggs et al., 2003 fentanyl citrate morphinedallam et al., 2003 fentanyl citra

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1 87 傷口換藥疼痛護理靳燕芬摘要 : 傷口換藥為促進傷口癒合之重要措施, 卻可能造成個案傷口疼痛本文探討影響傷口換藥疼痛之相關因素以及緩解傷口換藥疼痛措施之成效傷口換藥疼痛之相關因素包括 : 不適當的換藥技術發炎反應情緒認知與社會文化因素為緩解傷口換藥疼痛, 護理人員應採行合宜換藥技術, 選用非黏著性之敷料或使用換藥頻率較低之換藥方式可運用音樂治療與芳香療法以緩解換藥後之傷口疼痛, 但運用分散注意力法時, 應考量個案之個別差異性關鍵詞 : 傷口換藥疼痛護理 Stotts 2004 Meaume Teot Lazareth Martini Bohbot % 79.7% Ersek & Poe, 2004 Moffatt, Franks, & Hollinworth, 2003 Dallam, Barkauskas, Ayello, & Baranoski, 2003 Ersek & Poe, 2004 Briggs, Torra i Bou, & European Wound Management Association, 2003 Briggs et al.,

2 88 Wound Care Pain Weinberg 2000 Briggs et al., 2003 Ersek & Poe, 2004 Briggs et al., 2003 fentanyl citrate morphinedallam et al., 2003 fentanyl citrate fentanyl citrate Roberts et al., 2003 fentanyl citrate morphine Borland, Bergesio, Pascoe, Turner, & Woodger, 2005; Finn et al., 2004 fentanyl citrate patient-controlled analgesia Prakash, Fatima, & Pawar, 2004 EMLA eutectic mixture of local anesthetics creamlidocaine procaine Evans Gray 2005 EMLA EMLA 20 EMLA lidocaine 1% or 4% Doughty, 2004 Meaume % 95% Dallam et al., 2003; Doughty, acticoat mepital mefix

3 89 alginate lipidocolloid urgotul 50% hydrocolloidmeaume et al., 2005 Lalau et al., 2002 vacuum-assisted closure Krasner, 2002 Mendez-Eastman, 2002 Krasner, 2002; Mendez-Eastman, 2002 Kane Fratianne 2001 musical alternate engagement 2005 Kane 2004 Miller, Hickman, & Lemasters, 1992 Landolt, Marti, Widmer, & Meuli, 2002 Lasoff McEttrick 1986 Doughty 2004

4 90 Wound Care Pain Borland, M. L., Bergesio, R., Pascoe, E. M., Turner, S., & Woodger, S. (2005). Intranasal fentanyl is an equivalent analgesic to oral morphine in paediatric burns patients for dressing changes: A randomised double blind crossover study. Burns: Journal of the International Society for Burn Injuries, 31(7), Briggs, M., Torra i Bou, J. E., & European Wound Management Association (2003). Addressing the pain: Understanding the origin of wound pain during dressing change. Ostomy Wound Management, 49(2), Dallam, L. E., Barkauskas, C., Ayello, E. A., & Baranoski, S. (2003). Pain management and wounds. In C. Barkauskas & E. A. Ayello (Eds.), Wound care essentials: Practice principles (pp ). Philadelphia, PA: Lippincott Willikins. Doughty, D. B. (2004). Strategies for minimizing chronic wound pain. Home Healthcare Nurse, 22(11), Ersek, M., & Poe, C. M. (2004). Pain. In S. M. Lewis, M. M. Heitkemper, & S. R. Dirksen (Eds.), Medical-surgical nursing: Assessment and management of clinical problems (pp ). St. Louis, MO: Mosby. Evans, E., & Gray, M. (2005). Do topical analgesics reduce pain associated with wound dressing changes or debridement of chronic wounds? Journal of Wound, Ostomy & Continence Nursing, 32(5), Finn, J., Wright, J., Fong, J., Mackenzie, E., Wood, F., Leslie, G., et al. (2004). A randomised crossover trial of patient controlled intranasal fentanyl and oral morphine for procedural wound care in adult patients with burns. Burns, 30(3), Fratianne, R. B., Prensner, J. D., Huston, M. J., Super, D. M., Yowler, C. J., & Standley, J. M. (2001). The effect of music-based imagery and musical alternate engagement on the burn debridement process. Journal of Burn Care & Rehabilitation, 22(1), Kane, F. M., Brodie, E. E., Coull, A., Coyne, L., Howd, A., Milne, A., et al. (2004). The analgesic effect of odour and music upon dressing change. British Journal of Nursing, 13(19), S4 S12. Krasner, D. L. (2002). Managing wound pain in patients with vacuum-assisted closure devices. Ostomy Wound Management, 48(5), Lalau, J. D., Bresson, R., Charpentier, P., Coliche, V., Erlher, S., Ha Van, G., et al. (2002). Efficacy and tolerance of calcium alginate versus vaseline gauze dressings in the treatment of diabetic foot lesions. Diabetes & Metabolism, 28(3), Landolt, M. A., Marti, D., Widmer, J., & Meuli, M. (2002). Psychosocial forum. Does cartoon movie distraction decrease burned children s pain behavior? Journal of Burn Care & Rehabilitation, 23(1), Lasoff, E. M., & McEttrick, M. A. (1986). Participation versus diversion during dressing change: Can nurses attitudes change? Issues in Comprehensive Pediatric Nursing, 9(6), Meaume, S., Teot, L., Lazareth, I., Martini, J., & Bohbot, S. (2004). The importance of pain reduction through dressing selection in routine wound management: The MAPP study. Journal of Wound Care, 13(10), Meaume, S., Ourabah, Z., Cartier, H., Granel-Brocard, F., Combemale, P., Bressieux, J. M., et al. (2005). Evaluation of a lipidocolloid wound dressing in the local management of leg ulcers. Journal of Wound Care, 14(7), Mendez-Eastman, S. (2002). Wound therapy. Nursing, 32(5),

5 91 Miller, A. C., Hickman, L. C., & Lemasters, G. K. (1992). A distraction technique for control of burn pain. Journal of Burn Care Rehabilitation, 13(5), Moffatt, C. J., Franks, P. J., & Hollinworth, H. (2003). An international perspective on wound pain and trauma. Ostomy Wound Management, 49(4), Prakash, S., Fatima, T., & Pawar, M. (2004). Patient-controlled analgesia with fentanyl for burn dressing changes. Anesthesia & Analgesia, 99(2), Robert, R., Brack, A., Blakeney, P., Villarreal, C., Rosenberg, L., Thomas, C., et al. (2003). A double-blind study of the analgesic efficacy of oral transmucosal fenanyl citrate and oral morphine in pediatric patients undergoing burn dressing change and tubbing. Journal of Burn Care & Rehabilitation, 24(6), Stotts, N. A., Puntillo, K., Morris, A. B., Stanik-Hutt, J., Thompson, C. L., White, C., et al. (2004). Wound care pain in hospitalized adult patients. Heart and Lung, 33(5), Weinberg, K., Birdsall, C., Vail, D., Marano, M. A, Petrone, S. J., & Mansour, E. H. (2000). Pain and anxiety with burn dressing changes: Patient self-report. Journal of Burn Care Rehabilitation, 21(2), Nursing Management of Wound Care Pain Yen-Fan Chin Abstract: Wound care is an important step in promoting wound healing, but it may cause wound care pain. This article aims to explore factors influencing wound care pain and the effectiveness of various interventions to alleviate it. Five major factors that influence wound care pain include inappropriate dressing change techniques, inflammation response, emotion, cognition, and social-cultural factors. Nurses should apply appropriate dressings and dressing change techniques to relieve wound care pain. Music therapy and aromatherapy can alleviate wound pain after dressing change. But distraction techniques should be used in conjunction with consideration of the needs of the individual subject. Key Words: wound care, pain, nursing. RN, MSN, Instructor, School of Nursing, Chang Gung University. Received: September 5, 2006 Revised: September 26, 2006 Accepted: March 16, 2007 Address correspondence to: Yen-Fan Chin, No. 259, Wen-Hwa 1st Rd., Kwei-Shan, Taoyuan 33302, Taiwan, ROC. Tel: 886(3) ext. 5189; yenfan@mail.cgu.edu.tw

嚴重燒傷護理運用羅氏適應模式於一位嚴重燒傷病患之護理經驗鄭惠瑩丘周萍摘要本篇個案報告是照護一位嚴重燒傷病患之護理經驗筆者於護理期間運用羅氏適應模式的護理過程以觀察會談及身體評估等方式收集資料確立個案有皮膚完整性受損疼痛身體心像紊亂等護理問題護理期間筆者傾聽關懷並接納

嚴重燒傷護理運用羅氏適應模式於一位嚴重燒傷病患之護理經驗鄭惠瑩丘周萍摘要本篇個案報告是照護一位嚴重燒傷病患之護理經驗筆者於護理期間運用羅氏適應模式的護理過程以觀察會談及身體評估等方式收集資料確立個案有皮膚完整性受損疼痛身體心像紊亂等護理問題護理期間筆者傾聽關懷並接納嚴重燒傷護理運用羅氏適應模式於一位嚴重燒傷病患之護理經驗鄭惠瑩丘周萍摘要本篇個案報告是照護一位嚴重燒傷病患之護理經驗筆者於護理期間運用羅氏適應模式的護理過程以觀察會談及身體評估等方式收集資料確立個案有皮膚完整性受損疼痛身體心像紊亂等護理問題護理期間筆者傾聽關懷並接納其心中感受減輕個案在治療過程中的不確定感增加自主性與安全感協助個案以正向的態度來適應此創傷