一位呼吸衰竭病患對脫離呼吸器過程不確定感之護理經驗

The Nursing Experience of Uncertainty in a Patient with Respiratory Failure During Weaning Mechanical Ventilation

不確定感是影響病人在疾病、治療及住院經驗中的一個重要因素，嚴重時可能會影響到疾病復原的過程。當病人在脫離呼吸器的過程中，生理及心理上的壓力會讓病患產生不確定感。本篇個案報告是探討一位呼吸衰竭病患在加護病房中脫離呼吸器過程不確定感的照護經驗。個案因疾病症狀嚴重度高，加上發病過程與過去經驗不同，無法預期未來病情的進展，致個案對病情、治療及預後感到不確定。個案藉由學習及行動來處理在加護病房所面對的問題及治療，所採取的因應策略有哭泣、無助感及一直按呼叫鈴，以及配合治療解決問題之因應策略。在脫離呼吸器的過程中，提供重覆的解釋及雙向的溝通方式可降低不確定感。持續地提供相關的資訊以及給予心理支持，可遏止在使用呼吸器時所產生的不安全感。報告中的臨床經驗，期望能提供日後照護類似個案的護理人員，協助病患發展出合適的因應行為。

Uncertainty is an important factor that affect patients' perceptions during hospitalization. It can affect the outcome of the recovery process. Weaning from mechanical ventilation is a complex and stressful process for patients. Both physical and psychological stresses during this process can induce uncertainty. This case study examined the uncertainty in a patient with respiratory failure during weaning mechanical ventilation. Uncertainty of prognosis, treatment and outcome were the sources of uncertainty experience of this case. Learning and action are two ways dealing with the problems related to treatment in the process of uncertainty appraisal. Coping strategies included crying, hopelessness and seeking for help. Repeated explanation and effective mutual communication are useful in reducing patients' feelings of uncertainty and stress. The nursing experience from this case study can provide clinical nurses to help patients in the same situation developing positive coping behaviors.