- 期刊
運用共享決策協助一位急性心肌梗塞病人接受葉克膜之急診護理經驗
Providing Extracorporeal Cardiopulmonary Resuscitation to a Patient with Acute Myocardial Infarction and Ventricular Fibrillation: An Emergency Nurse's Perspective
摘要
本文描述一位84歲男性因急性心肌梗塞引發心室纖維顫動，急診團隊於第一時間啟動搶救流程。於2023年4月1日急診護理期間，以直接護理、觀察及會談方式收集資料，以Gordon十一項健康功能型態進行整體性評估，確立病人主要健康問題有一、氣體交換障礙／與肺水腫及呼吸性酸中毒有關；二、抉擇衝突／與對葉克膜治療及預後不甚了解，以致無法替病人決定是否需放置葉克膜有關；三、心輸出量減少／與心肌酵素異常及心律不整有關。由於病人雖年長，但求生欲望強烈。因此急診團隊導入醫病共享決策，透過醫療決策輔助工具幫助家屬對葉克膜治療有更清晰的理解，並做出符合病人價值觀及偏好的決定。同時整合跨團隊相關資源，如葉克膜照護團隊以及社工師、院牧人員等，提供病人與家屬在忙碌的急診就醫環境下，除了生理層面可得到專業團隊的搶救外，亦有院牧人員能即時提供家庭信仰的寄託。透過此急診照護經驗分享，啟發護理人員認識自我角色功能，於急診照護過程中，打破過去臨床緊急與忙碌的限制，滿足病人與家屬於第一時間所需的生理舒適及心理安適。
並列摘要
This is the case study of an 84-year-old man experiencing ventricular fibrillation due to an acute myocardial infarction that prompted an emergency medical team to initiate resuscitation procedures. Data were collected during emergency nursing on April 1, 2023, through direct care, observation, and conversations. A comprehensive assessment using Gordon's 11 Functional Health Patterns was conducted, and the following problems were identified: 1) Impaired air exchange related to pulmonary edema and respiratory acidosis; 2) indecision owing to not understanding extracorporeal membrane oxygenation (ECMO) treatment and prognosis, leading to uncertainty in deciding whether to place the patient on ECMO; and 3) decreased cardiac output linked to abnormal cardiac enzymes and arrhythmias. Despite the patient's advanced age, he exhibited a strong desire to survive. Therefore, the emergency medical team introduced shared decision-making and utilized patient decision aids to assist the family in understanding ECMO treatment and help them make decisions in line with the patient's values and preferences. In the process, interdisciplinary resources from the ECMO care team, social workers, and chaplains were combined to provide timely support for the patient and family in the complex emergency care environment. This approach ensured that the patient not only received professional medical interventions for his physical conditions but also received counsel in accordance with his religious beliefs from the chaplains. This experience prompted the involved team of nursing professionals to reevaluate their roles and look beyond the scope of previous clinical emergencies and their strenuous workloads to meet the immediate physical and spiritual needs of their patients and patients' families in the process of providing emergency care.