以病人為中心協助呼吸器依賴患者完成請假回家的心願

A Patient-Centered Care Plan for A Ventilator-Dependent Patient with Short-Term Leave from Hospital

吳佩芝(Pei-Chih Wu) ； 楊淑寬(Shu-Kuan Yung) ； 陳怡青(Yi-Ching Chen) ； 惠群(Chun Hui)

《安寧療護雜誌》 19卷3期 (2014/11) Pp. 309-322

https://doi.org/10.6537/TJHPC.2014.19(3).7

摘要

科技進步，促使因慢性退化性疾病而導致的呼吸器依賴病人得以存活下來。此類病人依據健保局89年實施『全民健保呼吸器依賴患者整合性照護試辦計畫』，最終只能下轉至呼吸照護病房或居家照護，繼續執行呼吸器脫離訓練。此類病人除了生活功能差，需依賴他人照護，且因生活品質逐漸降低而衍生出的焦慮、憂慮等心理問題更不容忽視。本篇為一慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease）的病人，因肺炎導致呼吸衰竭合併呼吸器依賴，無法順利脫離呼吸器，進而轉入呼吸照護病房，持續積極訓練呼吸器脫離。住院期間，以病人為中心的整合性照護，改善病人生活功能，增加自我照顧能力，藉由發聲閥的使用，瞭解生理的不適及心理需求。隨著自主活動功能的增加，伴隨而來的是住院無法回家的焦慮，使病人顯得鬱鬱寡歡。考量COPD合併呼吸器依賴病人之存活時間，無法有準確可靠之預估指標，依據「以病人為中心」的理念，協助家屬與病人溝通並擬定請假返家計畫以緩解醫療困境，達到病人和家屬身、心、靈痛苦症狀的緩解。

關鍵字

以病人為中心 ； 呼吸器依賴 ； 生活品質

並列摘要

The number of patients dependent on prolonged mechanical ventilation (PMV) after acute critical illness has increased sharply because of improvements in critical care techniques. In Taiwan, patients with PMV have been assigned to an integrated delivery system since 2000, which follows a step-down principle outlined by the Bureau of National Health Insurance policy. Patients will be stepped down to a respiratory care ward (RCW) or sent back home with the goal of weaning them off ventilation and continuation of chronic care. In addition to multiple medical comorbidities, these patients usually have psychological stresses, such as anxiety, social withdrawal, depression or chronic insomnia. This report described a senior lady with respiratory failure due to chronic obstructive pulmonary disease and pneumonia. She was admitted to RCW due to ventilator dependency. A patient-centered care plan was developed and the patient was trained to speak through the use of a speaking valve so that caregivers can understand how to cater to the patient's need. However, patient was so anxious that she had to stay in hospital for a long period of time because of illness. Another care plan of short-term leave from hospital was then prepared. This plan was devised to assure the patient could get home safely and enjoy family life.

並列關鍵字

patient-centered care ； ventilator dependence ； quality of life