- 期刊
一位生命末期患者選擇撤除維生醫療之護理經驗
Nursing Experience in Caring For an End-of-Life Patient Who Opted to Withdrawal from Life Support
摘要
雖然安寧緩和醫療條例已通過將末期病人已給予之維生醫療，在尊重病人的生命及醫療自主權下得以撤除。但實務執行面上卻常因醫護人員觀念上認為撤除維生醫療是自己積極作為而造成病患死亡，在心理上容易產生罪惡感而少有類似撤除案例的探討。故本文旨在描述一位生命末期入住加護病房病人其選擇撤除維生醫療的照護經驗。筆者經由觀察、身體評估與家屬會談等方式收集資料，並以戈登（Gordon）十一項功能性健康型態評估模式為指引，確立個案有：急性疼痛、心靈困擾、家屬預期性哀傷等主要護理問題。經由提供個別性的護理措施，降低疼痛不適感，鼓勵個案說出面對死亡之心靈困擾並協助其達到身、心、靈性及社會的善終狀態。至於家屬預期性哀傷的問題，則透過傾聽、陪伴關懷並藉由宗教信仰的力量，引導家屬面對個案即將死亡的事實，最終能彼此敘說內心感受完成四道人生（道謝、道歉、道愛、道別）。藉由本篇個案報告，提供醫療人員日後照顧此類個案之參考。
並列摘要
Although amendments to the Hospice Palliative Care Act stipulate that the life support provided to end-of-life patients may be withdrawal on the premise that patients’ wishes and their autonomy in medical treatment decisions are fulfilled. However, such stipulation is difficult to implement in practice because health professionals often believe that withdrawal life support is a positive action that causing patient death. This belief typically elicit sense of guilt in these health professionals. Consequently, few investigations have focused on cases of life support withdrawal. This study presents a case report of a nursing experience in caring for a end-of-life ICU patient who chose to withdrawal from life support. The author collected data through observations, physical assessments, and interview with family members, using the Gordon's Functional Health Patterns as a guideline. The case patient was determined to have experienced the following problems: acute pain; spiritual distress and expectant grievance among family members. Providing individualized nursing measures to the case patient alleviated the pain and discomfort in the patient, encouraged the patient to express the spiritual distress regarding death, and assisted the patient in preparing for a peaceful death, physically, mentally, and spiritually. Regarding the expectant grievance among family members, by listening to them, accompanying them, and imparting words of religious beliefs, family members were guided to prepare for and accept death. Through this process, family members could eventually express their feelings, thus fulfilling the four principles of life (love, gratitude, forgiveness, and grace in bidding farewell). This case report can serve as a reference for health care professionals when caring for end-of-life patients who choose to withdrawal from life support.