一位嚴重腦創傷病人生命末期之照護經驗

本文旨在描述協助一位意外導致嚴重腦創傷病人生命末期之全人照護經驗。筆者於2018年5月3日～2018年5月12日加護病房照護期間，運用五大層面護理進行評估，確立個案健康問題有組織灌流失效、自主性換氣失能以及預期性哀傷。筆者與醫療團隊運用生命末期概念，以陪伴、傾聽協助病家面對死亡的衝擊，因案妹為自閉症低智商青少年，對於面臨依賴的兄長瀕死的不知所措，藉由藝術治療及社工引導，使案妹能運用繪畫表達其哀傷的情緒及想法。筆者認為臨床上醫護人員除了需重視病人本身的醫療照護，亦要周全顧家屬的感受，若護理人員能具備哀傷和安寧緩和療護相關的概念，提早發現病家哀傷情緒並介入，相信較能提供高品質的緩和安寧護理照護。希望透過本次照護經驗分享，對日後照護此類病人的醫護人員能有所助益。

關鍵字

創傷；生命末期；預期性哀傷

並列摘要

The purpose of this paper is to describe the experience of assisting a patient at the end of life with severe brain trauma through holistic care. During the period of care in the intensive care unit from May 3, 2018 to May 12, 2018, five dimensions of assessment were used and three nursing care plans were established. Which were: Ineffective Cerebral Tissue Perfusion, Impaired Spontaneous Ventilation and Grieving. The author and the medical team made use of the concepts of end of life, companionship, and listening to help the patient's family members face the impact of patient's death. As the patient's younger sister is an adolescent with autism and low IQ, she is overwhelmed with her dying older brother whom she is dependent on. With the guidance of art therapy and the help of social workers, patient's sister was encouraged to use painting to express her sad emotions and thoughts. The author believes that clinical medical staff should not only pay attention to the individual patient's medical care, but also should fully consider the family members' feelings and emotions towards patient's illness and even death. If nursing staff could possess concepts of grief, tranquility and palliative care, and can detect the patient's family's grief early on and intervene, it is believed that high-quality palliative and tranquil nursing care can be provided. Through the sharing of this nursing care experience, it is hoped that it will be helpful to medical staff caring for such patients in the future.

並列關鍵字

trauma ； end of life ； anticipatory grief

參考文獻

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黃馨葆、陳皇吉、蔡佩渝、謝雅琪、林楷煌、蔡兆勳（2014）‧如何以家庭會議協助重症病人生命末期決策‧安寧療護雜誌，19(3)，268-281。doi:10.6537/TJHPC.2014. 19(3).4

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國際替代計量

一位嚴重腦創傷病人生命末期之照護經驗

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