一位車禍喪偶高齡硬腦膜下出血病人之護理經驗

本文描述一位高齡長者因車禍導致硬腦膜下出血，因同事故面臨喪偶引發哀傷的護理經驗。護理期間自2022年6月3日至6月15日，藉由Gorden十一項功能健康型態為評估架構，運用身體評估、觀察、會談、傾聽、電子病歷查閱等方式進行資料蒐集，確立個案有顱內壓調適能力降低、皮膚完整性受損及哀傷之健康問題。照護過程主要護理措施包含：一、提供舒適環境減少過度刺激、衛教採高纖維飲食以預防便秘限制伐式操作之活動，以避免顱內壓升高；二、身體多處擦傷，以無菌標準技術換藥預防感染，並衛教飲食選擇優質蛋白質及高維生素C以促進傷口癒合；三、面對喪偶引起哀傷情緒，安排醫院的社工及關懷師輔導，在關懷慰問的過程中引導個案說出內心感受，並配合宗教信仰尋求心靈的慰籍，導入寵物陪伴，提供情感依附及精神寄託，幫助轉移對喪偶之哀傷情緒；因應疫情，鼓勵家屬使用通訊軟體互動，強化家庭支持功能，減少個案孤獨感，因而改善三個健康問題。照護經驗發現長者喪偶的悲傷，難以用語言清楚表達，容易導致情緒潰堤，運用寵物陪伴、跨專業團隊協助及家屬與親友關懷，可幫助個案抒發悲傷情緒，坦然面對親人離世的事實，重新找到生活動力，回歸日常生活，故撰筆分享，以提供臨床照護參考。

關鍵字

高齡；車禍喪偶；哀傷

並列摘要

This article describes the nursing experience of an elderly man who faced the grief of losing his wife in a car accident. During the nursing period from June 3 to June 15, 2022, we applied the Gordon 11 function health patterns to collect data, using physical examination, observation, interview, listening, electronic medical records and other methods. We also confirmed that the patient had health problems of decreased intracranial adaptive capacity , impaired skin integrity, and grieving. The nursing measures used for his problems included: 1. We provided a comfortable environment to reduce over-stimulation, educated to adopt a high-fiber diet to prevent constipation, and educated to avoid perform Valsalva maneuver when moving limbs, to avoid increasing intracranial pressure; 2. When caring for multiple abrasions over the body, we used aseptic approach to change wound dressings and to prevent infection, and also we educated to adopt a diet rich in high-quality protein and vitamin C to enhance wound healing; 3. When facing the grief from the loss of his wife, we arranged hospital social workers and spiritual care staff, in the process of caring and condolences, to help the patient to disclose his inner feelings, and to seek spiritual solace in conjunction with his religious beliefs. What's more, through the care and companionship of pets, he can gain emotional connection and spiritual sustenance from them, to distract his emotions from his wife. In response to the COVID-19 pandemic, we encouraged family members to use communication APP software to keep in contact, strengthen family support function, and relieve the loneliness of the patient. The grief of elderly widowers is difficult to express clearly in words, and can easily lead to emotional breakdown. However, with the effectiveness of companionship and interaction from pets, the assistance of multi-disciplinary professional teams, and the love from family members and friends, we can help patients relieve their grief and calmly face the fact that their beloved ones have passed away. We hope that they can find the motivation for life again, improve the quality of life, and return to daily life as soon as possible,therefore, I write this article to share to provide reference for clinical care.