一位末期慢性阻塞性肺病病人之安寧加護護理經驗

Nursing Experience of Palliative Care for Patients with End-Stage Chronic Obstructive Pulmonary Disease in Intensive Care Units

末期慢性阻塞性肺病病人常因病情急性惡化，轉入加護病房接受侵入性治療，承受無效醫療造成的不適卻鮮少接受安寧療護。本文是探討末期慢性阻塞性肺病病人，因反覆感染肺炎致呼吸衰竭入住加護病房之照護經驗。護理期間自2014 年2 月18 日至3 月6 日，筆者藉由病歷收集、身體評估、傾聽、觀察、會談等方式收集資料，運用Gordon 十一項健康功能性型態進行整體性評估，確立個案有低效性呼吸型態、無望感、家屬預期性哀傷等健康問題。護理期間先協助個案渡過呼吸衰竭的急性期，並建立良好的護病關係，降低其無望感轉以正向態度接受非侵襲性正壓呼吸器治療；另陪伴家屬調適哀傷情緒，以重症安寧理念協助個案渡過疾病末期的各種身、心、靈困境。建議針對入住加護病房之末期慢性阻塞性肺病病人，介入全人整合跨領域團隊力量，提供重症安寧加護照護。

Patients with end-stage chronic obstructive pulmonary disease (COPD) in intensive care units (ICUs) frequently receive excessive invasive treatments because of acute deterioration in their clinical conditions; they experience an increasing number of uncomfortable symptoms caused by ineffective treatments and receive inadequate hospice care. This paper describes the nursing experience of a patient with end-stage COPD admitted to an ICU because of recurrent pneumonia leading to respiratory failure. The nursing period was from 18th February to 6th May, 2014. The author collected data through a physical assessment, listening, observation, and an interview, and applied Gordon's 11 Functional Health Patterns to comprehensively assess the patient. The health problems of the patient were identifi ed and were as follow: low effective breathing pattern, hopelessness, and anticipatory grief. According to the standard critically ill palliative care, we initially helped the patient endure the acute stage of the respiratory failure during the nursing period, fostered stronger nurse-patient relationships, and minimized the feeling of hopelessness. The patient accepted noninvasive positive airway pressure ventilator with a positive attitude. Furthermore, we helped the family accommodate themselves to the grief and face the impending bereavement, and helped the patient survive the physical, mental, and spiritual uncertainly associated with the terminal stage of the disease. Our findings suggest that collaborative and interdisciplinary teams should provide holistic health care to patients with end-stage COPD in the ICU.