- 期刊
協助一位慢性阻塞性肺病末期病人撤除維生治療之護理經驗
The Nursing Experience of Forgoing Life-sustaining Treatment for a Patient with Chronic Obstructive Pulmonary Disease (COPD) in the End of Life
摘要
本文敘述一位慢性阻塞性肺疾病末期病人，經歷氣切及一連串積極治療後仍無法脫離呼吸器，因病況持續惡化，進入生命末期階段。護理期間自2014年6月3日至2014年6月24日，透過觀察、會談、身體評估及病歷查閱等方式收集資料，以紐曼系統模式進行全人評估外，還包括家人互動關係，以及外在環境對其影響，作為緩和醫療介入依據。確立主要健康問題為:個案因疾病末期病徵導致低效性呼吸型態；家屬面對個案受苦及不捨之情衝擊下，在積極醫療介入效果不佳及安寧療護間產生家屬抉擇衝突；以及面臨個案死亡之家屬預期性哀傷。運用安寧療護的「四全」理念方法，緩解個案呼吸困難，增進其身體舒適；傾聽並釐清家屬所面臨醫療決策的心理衝擊及疑問，同理家屬的預期性哀傷給予情緒支持，透過安寧共照方式與家屬召開數次家庭會議，協助作出決策及準備個案撤除維生治療臨終過程及完成病人的心願；提供生命末期照護知識及資源，降低決策衝突，達到死者善終、生者心安的照護終極目標。
並列摘要
This article describes the nursing experience of caring for a patient with chronic obstructive pulmonary disease (COPD) at the end of life who underwent the process of forgoing life-sustaining treatment. Although he received a tracheostomy operation and various treatments, his health was rapidly worsening during my attending to the patient between 3rd and 24th of June 2014. The patient’s major health problems were identified based on the assessment utilizing with Neuman systems model as the follows: ineffective breathing pattern, decisional conflict, and anticipatory grief of family. The concept of Four Holistic Principles in hospice care- the whole person, the whole family, the whole course of the disease, the whole interdisciplinary team-was employed to alleviate dyspnea of the patient to further increase his physical comfort. Family conference is used to discuss the withdrawal of life- sustaining treatments, deal with the conflict over the options of different treatments, and identify the therapeutic goal finally. In this case, the goals of hospice care - the dead left peacefully and the remaining were comforted-were well.