協助腦死病人撤除維生醫療家庭適應經驗

Experience of Helping a Family to Adapt to the Withdrawal of Life-Sustaining Treatment of a Patient with Brain Death

李昀容(Yun-Jung Lee) ； 梁露珍(Lu-Chen Liang)

《安寧療護雜誌》 23卷2期 (2019/06) Pp. 178-190

https://doi.org/10.6537/TJHPC.201906_23(2).06

摘要

本篇個案報告主要描述一個家庭，為了照顧一位雙胞胎青少年病人因車禍造成腦死的適應歷程，從原本不願接受，經過三周的煎熬後，最後在醫療團隊的建議之下，家屬決定撤除維生醫療，期間經歷到外人難以想像的心理歷程。筆者在2016年6月14日至6月27日期間，經由實際觀察、參與式照顧及身體評估，訪談案父、母、兄，依照身心靈社會部分，整合為幾個核心主題：「關心病人身體狀況改變」、「家屬為病人擔憂而造成身體機能減弱」、「用盡辦法，否認」、「接受現實」、「回顧病人一生」、「感恩」、「宗教信仰作為支持」，及其護理問題有焦慮及預期性哀傷等問題，藉由家庭會議了解病人家屬的想法，適時的給予澄清，提供醫療決策之分享，加強家屬認知即將面對的失落事實，協助其適應正常的悲傷過程。過程中，筆者發現以家庭為中心參與決策之重要性，護理人員須適時引導，協助面對與減輕可能面臨之壓力。

關鍵字

撤除維生醫療 ； 適應 ； 壓力 ； 頭部外傷 ； 家庭

並列摘要

This case study reports the case of a family caring for one of their adolescent twins who had become brain following a car accident. Specifically, it depicts the unimaginable experience of the family, describing their denial immediately after the tragedy before finally taking the advice of the medical team and withdrawing life sustaining treatment. During June 14-27, 2016, the author assessed the sociopsychological state of the father, mother, and brother in the family through observation, participatory care, and physical assessment. The core themes of their experience are categorized as follows: concern for changes in the patient's condition, deterioration in the health of the family members caused by anxiety, absolute denial, acceptance of the reality, reflections on the patient's life, gratitude, support from religious beliefs, nursing problems, anxiety, and anticipatory grief. Through attempts to understand the thoughts of the family during family meetings, provision of timely clarifications, and sharing of medical decisions, we increased the family's awareness of the inevitable loss they are going to face and helped them to adapt to the grieving experience. During this process, the author discovered the importance of making decisions with a family-centered mindset, realizing nurse aides should provide timely support and advice to help minimize the distress associated with tragedies.

並列關鍵字

withdrawal of life-sustaining treatment ； adaptation ； traumatic head injury ； family

參考文獻

衛生福利部統計處(2017 年，6 月)．105年國人死因統計結果．取自https://www.mohw.gov.tw/cp-16-33598-1.html

衛生福利部中央健康保險署(2013年，5 月)．102 年安寧緩和醫療條例部分修文修正案取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&webdata_id=3651

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