一位腦損傷產婦其家屬撤除維生醫療照護經驗

The Nursing Experience of Caring for a Serious Brain Injury Patient with Withdrawal of Life-Sustaining Treatment

石佩勳(Pei-Hsun Shih) ； 彭月珠(Yueh-Chu Peng) ； 柯惠娟(Hui-Chuan Ko)

《長庚護理》 31卷4期 (2020/12) Pp. 593-601

https://doi.org/10.6386/CGN.202012_31(4).0012

摘要

本文描述一位產後因子癇症造成嚴重腦損傷病人，歷經手術及一連串積極治療後，仍無法脫離呼吸器，疾病進展不可逆，家屬在長期照護及撤除維生醫療間兩難的決策過程。照護期間為2017年3月20日至4月18日，筆者透過直接照護、觀察及家屬會談進行資料收集，以紐曼系統模式進行評估，確立主要健康問題為潛在危險性感染、抉擇衝突、預期性哀傷等；提供完整撤除維生醫療資料，利用互動式表單釐清疑問，舉辦家庭會議，協助決策；預期性哀傷方面，同理哀傷，運用安寧療護理念，由藝術治療師協助全家執行手足模的製作，留下紀念，提供臨終照護資訊，降低抉擇衝突。護理過程中，深感護理人員對疾病末期關懷及如何利用團隊資源適切提供此類家庭照護的知識與能力不足，故建議產科病房可定期邀請醫療團隊成員，提供護理人員在職教育，提升照護此類個案的相關知識與照護技巧。

關鍵字

子癇症 ； 腦損傷 ； 撤除維生醫療 ； 安寧療護

並列摘要

This paper described the nursing experience of caring for a patient with serious brain injury caused by postpartum eclampsia who failed to withdraw from a ventilator after undergoing surgery and a series of active treatments, leading to irreversible disease progression. The patient was about to entered the end-of-life stage. The family members faced decision dilemma of continuing long-term care or withdrawing from life-support medical treatment. The care period was from March 20th, 2017 to April 18th, 2017. The author collected data through direct care, observations, and interviews with the family members. An assessment was carried out using the Newman system model to establish the major health problems, including potentially dangerous infections, conflicts of choice, and anticipatory grief. To help resolve decisional conflict among family members, a complete life-sustaining medical treatment withdrawal information was provided, interactive forms were used to clarify questions, and family meetings were held to understand the ideas of each family member and assist in decision-making. To alleviate anticipatory grief, in addition to empathy, an art therapist was introduced to to assist the family produce hand and foot models for remembrance. During the nursing care process, we realized that nursing staff's knowledge and competency in providing end-stage care were inadequate. We managed to utilize team resources to appropriately provide such family care. Therefore, it is recommended that maternity wards regularly invite medical team members to provide in-service education to nurses in order to increase their knowledge of offering care to such patients and families, thereby improving the quality of care.

並列關鍵字

eclampsia ； brain injury ； withdrawal of life-sustaining treatment ； hospice care

參考文獻

吳家惠、高碧霞 (2010)．一位吞噬球缺乏症導致蜂窩性組織炎學齡前期兒童之護理．護理雜誌，57(2)，16-21。[Wu, C. H., & Gau, B. S. (2010). Nursing care of a preschool-age child with cellulites induced by phagocyte deficiency. The Journal of Nursing, 57(2), 16-21.] doi: 10.6224/JN.57.2S.16

林美伶、葉莉莉、陳清惠 (2009)．影響病人參與醫療決策之論述．護理雜誌，56(3)，83-87。[Lin, M. L., Yeh, L. L., & Chen, C. H. (2009). Patient involvement in medical decision making. The Journal of Nursing, 56(3), 83-87.] doi: 10.6224/JN.56.3.83

侯升雍、李茹萍 (2009)．護理人員照護癌末呼吸困難病患的知識、態度與行為趨向之研究．護理 雜誌，56(3)，46-56。[Hou, S. Y., & Lee, R. P. (2009). Nurses' knowledge, attitudes and behavior intentions in the care of terminal stage cancer patients with dyspnea. The Journal of Nursing, 56(3), 46-56.] doi: 10.6224/JN.56.3.46

康芳瑜、余珮蓉 (2009)．照顧一位口腔癌患者術後於加護病房的護理經驗．志為護理，8(4)，129-136。[Kang, F. Y., & Yu, Y. R. (2009). The nursing experience of an oral cancer patient in an intensive Care unit after surgery. Tzu Chi Nursing Journal, 8(4), 129-136.] doi: 10.6974/TCNJ.200908.0129

莊榮彬 (2004)．末期病人症狀處置之新進展．台灣醫學，8 (5)，657-663。[Chuang, R. B. (2004). New development of symptoms management in end-stage patients. Formosan Journal of Medicine, 8(5), 657-663.] doi: 10.6320/FJM.2004.8(5).08