一位罹患嚴重特殊傳染性肺炎（COVID-19）重症末期患者接受安寧療護經驗

Palliative Care Experience of a Terminally Ill Patient with Severe Special Infectious Pneumonia (COVID-19)

黃茱楹(Chu-Ying Huang) ； 劉曉菁(Hsiao-Ching Liu) ； 林承霈(Cheng-Pei Lin)

《安寧療護雜誌》 27卷1期 (2023/03) Pp. 79-99

https://doi.org/10.6537/TJHPC.202303_27(1).06

摘要

2021年台灣面臨嚴重特殊傳染性肺炎Coronavirus Disease-2019（COVID-19）確診與死亡人數直線攀升。病情變化迅速，引發病人及家屬面臨醫療的不確定性、臨終決策以及複雜性哀傷。本文描述一位罹患COVID-19末期患者接受安寧療護之經驗。病人與朋友餐敘後確診COVID-19，隔離期間突感呼吸費力，緊急入院治療，因疾病迅速惡化至末期，家屬面臨多次不確定而緊迫的醫療決策，且因防疫政策，病人須單獨在負壓隔離病房直至死亡，家屬無法陪伴在側且無法見最後一面的錐心之痛，產生自責、不捨等複雜性哀傷。照顧期間自2021年5月29日至6月18日，針對生理、心理、社會、靈性進行全人評估，確立健康問題有：氣體交換障礙、高危險性感染、便祕、預期性哀傷。透過多專科團隊合作、應用安寧緩和療護理念，提供症狀緩解、舒適照護，和家屬建立24小時視訊群組即時更新病況，讓無法陪伴在側的家人，透過視訊陪伴摯愛，直至生命末了，過程筆者引導四道人生、協助製作「記憶寶盒memory box」，減少家屬面對至親逝去時之遺憾與衝擊，協助病人與家屬獲得生理、心理、社會、靈性的整體安適。

關鍵字

新冠肺炎 ； 末期照護 ； 緩和療護 ； 哀傷撫慰 ； 舒適護理

並列摘要

In 2021, Taiwan faced a sharp increase in the number of confirmed coronavirus disease-2019 (COVID-19) cases and deaths. The rapid changes in condition resulted in uncertainty, end-of-life decision, and complicated grief in patients and family members. This paper described the experience of palliative care in an end-stage COVID-19 patient. During quarantine, the patient experienced labored breathing and was admitted to the hospital for treatment. As the patient's condition rapidly progressed to the end stage, the patient's family members faced many uncertain and pressing medical decisions. Due to pandemic control measures, the patient was required to remain in the negative pressure ward until death and family members were unable to accompany the patient and see the patient for the last time, resulting in heartache, and causing complicated grief such as self-blame and inability to part with the patient. The care period was from 29 May to 18 June, 2021. Holistic evaluation of physiological, psychological, social, and spiritual aspects was carried out and the health problems were determined to be gaseous exchange defect, high-risk infection, constipation, and anticipatory grief. Patients were provided with multidisciplinary team collaboration, use of palliative and hospice care, and provision of symptom relief and comfortable care. The establishment of a 24-hour video group with the patient's family members for real-time updating allowed family members to accompany the patient until the end through videos. During the process, the author guided the family members to express thanks, love, sorry, goodbye to the patient, created a memory box, decreased the regret and impact of loss of loved ones in the family members, and assisted the patient and family members to achieve physiological, psychological, social, and spiritual comfort.

並列關鍵字

Covid-19 ； end-of-life care ； palliative care ； bereavement care ； comfort care

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