一位頸椎骨折放棄治療選擇死亡病患之照護經驗

A Nursing Experience with a Patient who Suffered from Cervical Spine Fracture, Gave up any Treatment and Chose to Die

本報告描述因意外導致頸椎骨折之病患，得知將終身癱瘓且依賴呼吸器，決定選擇自然死亡之瀕死病患加護照護經驗。期間由2008年11月13日至2008年11月18日，採直接護理、觀察、病歷查詢及與家屬會談等方式收集資料，以Gordon十一項功能性健康型態評估，確立病患因頸椎骨折放棄治療面臨死亡而產生包括呼吸道清除功能失效、急性疼痛、身體活動功能障礙及預期性哀傷的護理問題。經整合性醫療團隊與病患及家人充分溝通後，決定以維持呼吸道通暢、適時給予止痛劑及精油按摩肢體與穴位、調整舒適臥位等促進舒適為前提之個別性的護理措施。並鼓勵病患及家屬在有限的時間裡，相互傾訴對預期性哀傷及失落的感受與需求，交代後事處置，依其意願協助辦理自動出院，使病患能在熟悉的家中與家人共處直至安祥離世。加護病房一向予人積極處置的印象，但為尊重本病患拒絕加護治療，選擇正向面對死亡之自主意願，加護團隊納入安寧療護之理念來協助病患及其家人，實為臨床極佳之加護護理經驗，提供臨床照護類似病患之參考。This report describes a patient who suffered from cervical spine fracture caused by car accident. When the patient was informed paralysis forever and had to live on ventilator dependence, he rejected any further treatment and allowed natural death. From 13th November to 18th November in 2008 we collected data through the use of Gordon's Functional Health Patterns. We assured that the patient had problems caused by cervical spine dislocation, such as ineffective airway clearance, acute pain, impaired physical mobility and anticipatory grief. With adequate discussion we decided to promote the patient's comfort, keep clearance of airway, and encourage the families to talk about the feelings from anticipatory grief and a sense of loss. Afterwards we helped patient discharge so that he could stay longer with the families at home till the death. To respect the patient's decision, the medical team applied hospice to help the families face the death with a positive attitude. This case is a rare example in clinical critical nursing which provides a kind of reference for others.