照護一位B型肝炎及愛滋病毒感染者引發急性肝衰竭瀕死個案之護理經驗

A Nursing Experience of Caring a HIV Patient with Acute Liver Failure Caused by Hepatitis B Infection

陳孟琪(Meng-Ci Chen) ； 巫怡翎(I-Ling Wu) ； 蔡慧于(Hui-Yu Tsai) ； 曾斐琳(Fei-Lin Tseng) ； 劉子琳(Tzu-Lin Liu)

《長庚護理》 30卷1期 (2019/03) Pp. 112-123

https://doi.org/10.6386/CGN.201903_30(1).0010

摘要

本文探討一位愛滋病毒及B型肝炎感染者引發急性肝衰竭瀕死之病人，因疾病導致腹水、黃疸、身體外觀改變，又因感染愛滋病毒無法執行肝移植，而面臨死亡威脅，造成生理及心理的雙重衝擊。護理期間自2015年11月8日至11月18日，運用五大層面健康評估技巧，藉由治療性會談、身體評估、觀察及直接照護等方式收集資料，確立病人有出血、身體心像紊亂及死亡焦慮等三項健康問題。護理人員經由真誠的關懷、傾聽、溝通等，建立信任的治療性關係，除依醫囑緩解生理不適外，藉由緩解出血問題提升病人生活品質、建立自信心接納身體外觀的改變，讓病人體會生命存在價值，完成病人對家屬的道謝、道歉及道別的心願，也讓其身、心、靈獲得滿足。照護過程中因筆者將病人及親屬間心靈照顧問題列為為優先改善，而忽略了病人及同性伴侶間也是需要好好道別，建議在照護此類型病人，宜在有限的時間內，依據個別需求安排心理及靈性照護措施，讓愛的表達更完整，期望此報告分享能提升護理人員對臨終病人的心理靈性需求敏感度，適時提供靈性照顧，讓病人得以無遺憾及獲得善終。

關鍵字

死亡焦慮 ； 愛滋病毒 ； 急性肝衰竭

並列摘要

This report described the nursing experience of caring a HIV patient who was near death for acute liver failure caused by Hepatitis B infection. Due to jaundice, change in the body's appearance, complicated with infection of HIV, the patient could not receive liver transplantation. He encountered the threat of death which negatively impact his physical and psychological health. The nursing period was from November 8 to 18 in 2015. During this period, health assessment skills in five major dimensions were conducted and therapeutic interviews, physical examinations, observations, and direct care were used to collect data. At this stage, it was confirmed that the patient suffered from three health problems - hemorrhage, body image disturbance, and death anxiety. On the other side, the nursing personnel had established a trustable therapeutic relationship through sincere care, listening, communication, and so on. Other than relieving the patient's physical discomfort in accordance with the doctor's advice, the patient's living quality had improved through the nursing measures. The patient thus improved problems like hemorrhage, and developed self-confidence to accept changes in his physical appearance, so that he could experience the value of life, express gratitude, apology, and farewell to his family, while his body, mind, and soul could obtain satisfaction. In the process of care, the author put spiritual care among the patient and his relatives as the first priority, but ignored that the patient needed to say farewell to his same-sex partner as well. As a result, it is suggested that for such type of patients, within the limited timeframe before the end of life, psychological and spiritual care measures should be arranged according to the individuality, so that love can be expressed even more completely. Lastly, it is expected that by sharing this report, the nursing personnel's sensitivity for the terminal patients' psychological and spiritual need can be raised, and spiritual care can be provided timely, so that the patients can leave the world without regret and peacefully.

並列關鍵字

death anxiety ； HIV ； acute liver failure

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