照顧一位冠狀動脈繞道手術病患因喪親面臨哀傷之護理經驗

本篇報告在探討一位接受冠狀動脈繞道手術的個案因得知親友突然去世而引發的身心反應。筆者於2012年10月3日至10月15日照護期間，運用Gordon功能性健康型態評估為指引，經由身體評估、會談、觀察及傾聽等方式進行評估，確立個案呈現急性疼痛、活動無耐力及哀傷等健康問題。筆者經由護理過程提供個案減緩疼痛的護理措施；鼓勵個案及家屬共同參與心肺復健計畫，增進個案的活動耐力。此外，因個案喪親產生的哀傷及情緒反應，醫護團隊協助個案及家屬渡過喪親的哀傷過程，給予持續性關懷、同理心及傾聽，引導個案抒發情緒，使其重新審視失落及返家後的生活。期望藉由此個案之護理經驗，提供臨床護理人員照護相關個案之參考。

關鍵字

冠狀動脈繞道手術；急性疼痛；活動無耐力；哀傷

並列摘要

This paper is to describe the experience of nursing care for a patient undergoing coronary artery bypass graft, who suffered grief because of bereavement, which induced both physical and psychological problems, the resulting impact on recovery after CABG. The period of nursing care was from October 3 to October 15 in 2012. The authors collected the information through interview, observation, physical examination, and application of Gordon's functional health patterns assessment guidelines for analysis. The results identified that the patient's health problems included acute pain, activity intolerance, and grief. In the nursing process, pain associated with disposal of providing care reduced postoperative pain, encouraged the patient and family participation in medical rehabilitation co-design team cardiopulmonary rehabilitation programs, and made him recover smoothly and increase his activity intolerance. Grief and loss incurred for the emotional reaction, the use of the concepts and principles of grief counseling, through continuous care, empathy and listening skills such as guiding the case to express negative emotions helped the patient and his family together pass through bereavement grief process and bring them to re-examine the meaning of loss for themselves in order to find a positive way to adapt to new life in the future. We expected to provide the nursing staff with an experience sharing and a reference when taking care of similar cases.