照顧一位敗血性休克病人無望感之加護經驗

Nursing Care Experiences of a Septic Shock Patient with Hopelessness at ICU

林慧雯(Hui-Wen Lin) ； 徐琬茵(Wan-Yin Hsu)

《馬偕護理雜誌》 12卷2期 (2018/07) Pp. 65-75

https://doi.org/10.29415/JMKN.201807_12(2).0006

摘要

本篇為描述一位敗血性休克合併瀰漫性血管內凝血，造成四肢壞死而須面臨截肢之照護經驗，護理期間自2015年9月13日至2015年10月19日，筆者運用羅式適應模式進行整體性評估，並經由觀察、會談、查閱病歷、身體評估收集資料，確立個案有組織灌流改變/腎臟、呼吸道清除功能失效、無望感等健康問題。因個案正值中年期，卻面臨四肢截肢之抉擇，出現冷漠不語及對未來產生無望感之負面情緒。護理期間運用同理心並陪伴傾聽建立信任感，經由會談溝通穩定情緒，鼓勵表達內心想法，進而協助個案正向思考面對疾病，於心理重建後產生正向信念適應改變，最終回復原有的生活型態，期望藉此加護病房之照護經驗與護理同仁分享，做為日後照護類似個案之參考。

關鍵字

敗血性休克 ； 組織灌流改變/腎臟 ； 呼吸道清除功能失效 ； 無望感

並列摘要

This case report describes the nursing care for a patient with septic shock combined with disseminated intravascular coagulation and faced four limb amputations due to gangrene. During the period from September 13 to October 19, 2015, the Roy’s Adaptation Model was applied to collect patient’s data through observations, interviews, physical assessments, and medical record reviews. Three major health problems of the patient were ineffective tissue perfusion (renal); ineffective airway clearance; hopelessness. Because the patient was at the period of midlife but had to face the decision of accepting four limb amputations, the patient showed negative emotions such as indifference, quiet, and hopelessness. The author empathetically accompanied and listened to the patient to establish trust, effectively communicated with the patient to stabilize his emotions, encouraged the patient to express thoughts, and further helped the patient to think positively to face the diseases. After reestablished positive beliefs and adapted to situational changes, the patient returned back to his used life style. This nursing care experience can be a reference for other healthcare providers to provide proper care to patients with similar situations.

並列關鍵字

Septic shock ； ineffective tissue perfusion (renal) ； ineffective airway clearance ； hopelessness