照護一位裝置左心室輔助器術後病人之護理經驗

本文為描述一位六十二歲男性因末期心臟衰竭裝置左心室輔助器術後護理經驗，照護期間2018年4月21日至5月12日，以Gordon's十一項健康功能型態做為評估工具。透過訪談、觀察、傾聽及身體評估來收集資料，分析病人主要問題：急性疼痛、活動無耐力及焦慮。針對病人健康問題給予個別性之照護計畫，運用非藥物方式緩解因換藥、咳嗽、活動導致的疼痛不適感；傾聽病人想法予回應與鼓勵，適時請醫師向病人及家屬解釋目前病況，復健期間評估病人狀況，隨時調整復健計畫，住院期間，隨時紀錄傷口狀況與醫生討論，及早教導家屬照護技巧，參與照護過程，讓家庭支持的角色突顯，增加病人安全感、減輕焦慮，也讓家人間的聯繫更緊密，包括指導病人及主要照護者認識左心室輔助器的操作及其常見之異常問題，發現這些方式可同時降低病人術後期間生理上與心理上的不適，從而提升自我照護信心。由於目前在台灣，裝置心室輔助器病人並不多見，護理人員在照護上，容易因不熟悉感到害怕，作者建議心室輔助器的模擬訓練課程是一個培養整個醫療照護團隊對心室輔助器的照護知識與能力的重要方法，冀望藉由此篇報告提供裝置左心室輔助器病人照護實務經驗，鼓勵往後照護類似病人之同仁分享經驗。

關鍵字

心臟衰竭；左心室輔助器

並列摘要

This article describes a nurse's experience in caring for a 62-year-old gentleman who received a left ventricular assist device (LVAD) implantation due to advanced heart failure. During the period of caring (from April 21, 2018, to May 12, 2018), the authors conducted a comprehensive nurse assessment for the patient with Gordon's Functional Health Pattern. Based on the information collected from interviews, observations, empathic listening, and daily physical assessments, the authors found that acute pain, exercise intolerance, and anxiety were the patient's core problems in nurse care. Therefore, the authors offered an individualized care plan to solve these problems. The applied strategies included using non-pharmacological methods to relieve the patient's pain following changing dressing, coughing, and moving. They also included performing scheduled wound assessment and reporting the abnormalities to the doctor-in-charge rapidly to detect infection early, and assessing the patient's progress in physical recovery daily to titrate the rehabilitation program to his needs. The authors also used empathic listening, positive responding, and education to reduce the patient's anxiety. These skills helped the authors to facilitate effective doctor-patient-family communications while necessary. By teaching the patient and his family caregivers about the principles of self-care of left VAD, the authors also recruited the family caregivers as a collaborator in patient care since the early postoperative period to enhance the engagement and support of family members. After conducting the abovementioned strategies, the patient reported less physical/psychological discomfort and showed increased confidence in self-care. Since the nurse experience in LVAD patients is still relatively rare in Taiwan, nurses often feel unfamiliar and scared while taking care of these patients. To reduce the fear of the unfamiliar in nurses, the authors suggested that simulation courses of LVAD might be a practical method to build up the team members' knowledge and ability to offer the standard care to the LVAD patients. Hopefully, our report could inspire our colleagues to share experiences in this aspect.