一位重症生命末期病人於加護病房之全人照護經驗

Experience of Holistic Care for Patients Requiring Critical End-of-Life Care in the Intensive Care Unit

張秀琳(Hsiu-Ling Chang) ； 孫培蕾(Pei-Lei Sun)

《榮總護理》 36卷1期 (2019/03) Pp. 72-79

https://doi.org/10.6142/VGHN.201903_36(1).0007

摘要

本文係描述一位肺癌末期病人因疾病過程急驟惡化轉入加護病房，病人本身及家屬面臨非預期急救、病況變化轉加護病房及經歷臨終壓力過程之全人照護經驗。照護期間為2014年10月22日至10月29日，藉由實際照護過程，採直接觀察、身體評估及會談技巧，運用全人照護理念，進行整體性評估，歸納出主要健康問題有：一、氣體交換功能障礙；二、疼痛；三、家屬預期性哀傷。照護期間評估病人健康問題及家屬需求，運用護理專業技能，維持生命徵象穩定及減輕疼痛，並提供相關訊息及指導，以增加個案舒適及家屬認知；運用正向情緒支持及持續陪伴，以減輕家屬心理焦慮，表達關懷；經由提供哀傷輔導與整體照護，協助病人達善終及家屬正向思考死亡議題。建議未來醫療團隊能建立以案例分享方式落實全人照護，並期望藉此護理經驗分享，提供重症單位護理人員對重症病人生命末期之全人照護之參考。

關鍵字

重症病人 ； 生命末期 ； 加護病房 ； 全人照護

並列摘要

This article describes the nursing care of a patient with terminal-stage lung cancer who was admitted to the intensive care unit due to sudden deterioration of health. Moreover, we share the experiences of the patient and the family members facing the unexpected emergency, changes in health condition, and the need for intensive care as well as their experiences with holistic care. During the nursing period October 22-29, 2015, problems associated with nursing care were identified through the actual holistic care process, direct observation, physical assessment, and conversation skills. The problems included abnormal gas exchange, pain, and the patient's wife's anticipated grief. During the care period, the caregiver had to use professional skills to assess the health problems of the patient and the family needs, maintain the patient's vital signs of life and reduce pain, provide relevant information and guidance to increase patient's comfort and the family's awareness, provide positive emotional support and company, reduce the psychological anxiety of the family members, provide bereavement counseling and holistic care, and coordinate with the family members to help the patient achieve positive thinking about death. On the basis of our study findings, we suggest future medical teams to implement a holistic approach to care for terminally ill patients. We believe our findings would act as a reference for caregivers providing critical end-of-life care to such patients.

並列關鍵字

critical patients ； end of life ； intensive care unit ； holistic care

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