一位心衰竭生命末期病人之心臟加護護理經驗

The Nursing Experience of an End-of-Life Patient with Heart Failure in the Cardiac Intensive Care Unit

陳凱琪(Kai-Chi Chen) ； 林鳳蓮(Feng-Lien Lin)

《臺大護理雜誌》 14卷2期 (2018/07) Pp. 70-83

https://doi.org/10.6740/NTUHJN.201807_14(2).0008

摘要

心衰竭診治指引強調醫療照護團隊應協助生命末期個案及家屬瞭解照護選項及參與照護決策。本文描述一位具有腎衰竭病史的心衰竭個案，因心因性休克急救後，面對生命末期之心臟加護護理經驗。照護期間為2015年9月13日至9月21日，經由整體性護理評估，歸納主要健康問題為心輸出量減少、組織灌流改變、死亡焦慮及預期性哀傷。護理措施包括：維持個案的心臟血流輸出功能；預防組織受損；醫療團隊詳細解說個案的病情與處置及安寧療護的醫療選擇；運用宗教信仰與道愛、道謝、道歉及道別，提供靈性的支持。雖然個案面臨生命末期的困境，但最後在心臟加護團隊的努力下成功地渡過個案臨終的歷程。建議心臟加護病房護理師應提升整體性照護及生命末期照護的能力，以協助個案及家屬參與照護決策及提升生死相安的照護品質。

關鍵字

心衰竭 ； 預期性哀傷 ； 焦慮 ； 心輸出量 ； 組織灌流 ； 心臟加護病房

並列摘要

The guideline for heart failure management emphasizes that the health care team should help patients and their families to explore care options and be involved in decision-making at the end-of- life. This report describes the nursing experience of an end-of-life heart failure patient with cardiogenic shock post-resuscitation in the cardiac intensive care unit. We collected the data of the patient and her family for holistic nursing assessment from September 13^(th) to 21^(st), 2015. We identified the patient's health issues, including decreased cardiac output, altered peripheral tissue perfusion, death anxiety, and anticipatory grieving. The nursing interventions included maintaining the patient's cardiac function; decreasing bleeding tendency and preventing tissue damage; explaining the patient's condition and the option of palliative care to the patient and her family; and providing spiritual support with religious belief, love, thanks, sorry, and farewell. This report showed that the patient successfully completed the journey after the efforts of the cardiac intensive care team, even though the patient faced the end-of-life dilemma. The cardiac intensive care nurses should improve their nursing competence in holistic and end-of-life care to improve care quality and share involvement in decision-making with patients and their families at the end-of-life.

並列關鍵字

heart failure ； anticipatory grief ； anxiety ； cardiac output ； tissue perfusion ； cardiac intensive care unit