一位心衰竭末期病人於加護病房中運用安寧照護理念善終之護理經驗

The Nursing Experience of A Terminal Stage Heart Failure Patients Receive Hospice Share Care Concept in the Intensive Care Unit

李平智(Ping-Chih Li) ； 張嫚娜(Man-Na Chang) ； 陳佩卿(Pei-Ching Chen)

《安寧療護雜誌》 22卷1期 (2017/03) Pp. 85-96

https://doi.org/10.6537/TJHPC.2017.22(1).7

摘要

本文是以安寧緩和共照模式，協助一位入住加護病房心衰竭末期病人及家屬面對生命末期的照護經驗。筆者於2013年5月20日至6月7日，依生、心理、社會與靈性層面進行評估，確立下列主要照護問題：（1）生理層面：體液容積過量/心、腎功能受損導致、疼痛/心衰竭及疾病進展導致；（2）心靈困擾/未準備好面對死亡。護理過程中，透過家庭會議方式，與病人、家屬、醫療共照成員共同擬定照護計畫。協助舒適臥位、藥物、氧療及限制水份，以減輕呼吸費力；使用冰枕、精油與穴位按摩、唸佛號、藥物等方法緩解疼痛；運用關懷、肢體接觸、陪伴，傾聽病人及家屬內心感受，適時運用安寧理念介入，使病人明白生命選擇的自主及尊嚴；彈性開放會客，讓家人陪伴，減輕焦慮及哀傷。隨時觀察反應，適時修正照護計畫。使病人及家屬能面對逐漸死亡的衝擊及哀傷反應，感受身、心、靈的全方位照護的生命末期護理。

關鍵字

安寧療護 ； 生命末期照護 ； 加護病房

並列摘要

This article is focus on nursing experience of hospice share care Concept in ICU for a terminal stage heart failure patients and their families face the end of life. The author form May 20 to June 7, 2013 according to the health, psychological, social and spiritual dimensions evaluated to establish the following primary caregiver issues: (1) physical issues including: body fluid overdose volume related to heart, kidney dysfunction, the pain of heart failure progression ; (2) social psychological issues: the crisis situation and is not ready to face death. Nursing process, through family conferencing with patients, their families and members of the medical to co-develop plan of care. Use of Comfortable supine, medicines, oxygen and water restrictions, in order to reduce respiratory distress; use ice pillow, massage with essential oils, recite numbers, drugs and other ways to ease the pain; use physical contact, accompany, listen patients and their families inner feelings, to study and positive coping strategies, so that patients understand the true meaning of life; flexible open time, let the family accompany, reduce anxiety and grief. Always observe the reaction, timely amendment care plan. So that patients and their families to face of gradually die the shock and grief reactions, feeling body, mind and spirit of all-round care of end of life care.

並列關鍵字

Hospice Share care ； end of life care ； intensive care unit

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