- 期刊
一位出血型中風病人面臨生命自決困境之護理經驗
The Nursing Experience of a Hemorrhagic Stroke Patient Facing Dilemma in Self-determination of Living
摘要
本文描述一位出血型中風病人面臨生命自決困境之護理經驗，照顧期間自2020年7月9日至8月7日，筆者透過直接照護、會談、觀察及病歷檢閱等方式，運用Gordon十一項健康功能型態進行整體性評估。住院期間隨著病情變化進展至生命末期，在家屬與病人意見相左的情況下，病人除有氣體交換障礙之健康問題外，還出現對於追求生命善終的無力感，而家屬則面臨病人死亡威脅的哀傷等健康問題。護理過程中，除了提供個別性護理外，秉持尊重病人自主權為生命末期照護之核心價值，並以病人為中心進行治療目標的溝通，透過家庭與個別會談的方式，引導病人與家屬進行對話，陳述內心的想法與感受；同時向家屬解說預立醫療決定之內涵，撫慰家屬的內疚與不捨。最終，病人獲得善終，家屬達成善別，生死兩無憾。期望藉此護理經驗，提供醫療人員照護相關個案之參考。未來，建議加強宣導病人自主權利法的核心概念及教育訓練，進行臨床經驗分享，並且透過情境模擬溝通課程，提升協助家庭面對生命末期決策困境及照護能力。
並列摘要
This article is talking about the nursing experience of a hemorrhagic stroke patient facing dilemma in self-determination of living. The period was from July 9th, 2020 to August 7th, 2020. The author did a holistic assessment with direct nursing, conversation, observation, reviewing medical records, and Gordon 11 Function Health Patterns. During hospitalization, it became a terminal illness. With the disagreement between patient and the family, the patient had gaseous exchange issue and felt powerless about pursuing a good death. While the family suffered from the coming death of the patient, during the nursing, besides providing individual caring, showing respect to patient's autonomy was the core value of terminal illness nursing, such as having conversation about treatment target with patient and family, guiding the patient to communicate with the family, describing their thoughts and feeling to each other, and explaining the connotation of Advance Decision to the family in order to smoothen their grief. In the end, the patient had good death. The family said goodbye with no regret. It is expected by providing this case, those who are health care workers could have a reference. In the future, we could disseminate the core connotation about Patient Right to Autonomy and have the training with experience sharing and scenario simulation to improve nursing with professionalism to help families to face the determination of living dilemma.