一位加護病房生命末期病患主要照顧者之照護經驗－運用壓力及因應處理模式

The Nursing Experience of Caring the Caregiver of a Patient at the End of Life in an Intensive Care Unit-Nursing Experience of Transactional Model of Stress and Coping

李菁娥(Ching-Er Lee) ； 林秋菊(Chiu-Chu Lin)

《長庚護理》 20卷4期 (2009/12) Pp. 550-557

https://doi.org/10.6386/CGN.200912_20(4).0013

摘要

重症病患進入加護病房，對病患是生理的危機，對其家屬而言主要是心理壓力與折磨。加護病房的死亡率一般皆大於l0%，當家屬在面對家人住於加護病房中，再加上生命已至末期時，其所造成之壓力是相當大，此壓力會導致家屬出現許多複雜之情緒反應及因應模式，因此，引發筆者運用壓力及因應模式評估家屬在壓力反應及因應方式之表現，並提供適當之照護。筆者於10月5日至11月27日期間，於加護病房照顧一位生命末期病患及其家屬，藉由觀察家屬在面對親人疾病治療及變化過程中，面對疾病改變壓力時之初級評價、次級評價及因應處理型態和社會資源等三方面之反應及處理型態，評估後發現病患之主要照顧者面對兩個主要問題，包括：(1)面對病患病情惡化的無法控制感；(2)親人即將死亡的失落。照護期間，筆者藉由與個案建立良好之關係，運用開放式會談技巧引導個案表達內心壓力感受，並藉由家庭支持系統之協助，讓個案心理獲得舒解，重新面對生活的改變，協助個案適當的渡過壓力危機。

關鍵字

生命末期 ； 加護病房 ； 壓力及因應處理模式

並列摘要

When critically ill patients are admitted to intensive care unit (ICU), it creates undoubtedly a physiological crisis for patients themselves and, meanwhile, causes mainly the psychological stress on family members. The ICU mortality is above 10% in general. Therefore, for family members, the stress of facing the situation that one of their family members is at the end of life in an ICU can be so tremendous that results inevitably in several complex stress responses as well as coping strategies. The above inspired the author for attempting to evaluate, by applying the Transactional Model of stress and coping, a main caregiver's appraisal of stress and coping strategies when dealing with the stress caused by caring a patient who was at the end of life and to provide with appropriate care. During the period of caring an ICU patient at the end of life and her family members from October 5th to November 27th in 2007, the author observed the main caregiver's responses and strategies in three aspects, including primary appraisal, secondary appraisal, and coping style as well as social resources. The study revealed two main problems that the main caregiver might face: (1) the inability of sense of control in dealing with worsening of the condition of the patient and (2) the feeling of loss when facing the patient near dying. During the caring period, by creating a sound relationship with the case, the author guided the case to express his inner stress by asking open-ended questions; moreover, with the assistance of the Family Support System, the author not only helped the case obtain relief from psychological stress and face the life changes but also assisted the case in weathering out the stress crisis.

並列關鍵字

end of life ； intensive care unit ； transactional model of stress and coping