照護一位間質性肺部疾病患者無望感之護理經驗

A Nursing Experience of Caring for a Patient with Hospelessness

本文描訴一位間質性肺部疾病重症患者因反覆置入氣管內管引發無望感之照護經驗。筆者運用Gordon十一項功能性健康型態作為評估架構，藉由觀察、會談、及身體評估等方法收集資料。確立個案主要護理問題為：氣體交換障礙∕與嚴重肺纖維化導致肺泡及微血管膜改變有關、無望感∕與病情不穩再次插管導致喪失信心有關、照顧者角色緊張∕家屬因愚者行氣管切開術面臨日後照顧問題而引發等問題。護理期間，除了維持正常氧合，定期監測動脈血液氣體分析並維持平衡，及個別性呼吸肌肉訓練外，提供心理支持，促使脫離呼吸器。透過跨團隊合作與家屬討論治療方向，積極主動關懷，減輕對疾病產生的焦慮及害怕，協助渡過無望感對醫療團隊建立信心，協助家屬因擔心氣切照護引發的焦慮緊張情緒，坦然面對日後照顧問題。希望藉此護理經驗建議醫護人員隨時注意病人及家屬之擔心與反應，藉良好之治療性人際關係建立協助適應渡過疾病發展過程。

This article describes a nursing experience for a patient with interstitial lung disease. The patient appeared hopeless after repeated events of endotracheal intubation. The author used Gordon's Functional Health Pattern for patient assessment. Data were collected by means of observation, interview, and physical assessment. Three identified nursing problems are impaired gas exchange and severe tissue fibrosis of the lung associated with pulmonary alveoli and microvascular change, a feeling of hopelessness and a loss of confidence due to unstable conditions and repeated intubation, and family tension resulting from care issues after the tracheostomy. During the nursing period, the patient was provided with oxygen, periodic blood gas monitoring for balance, individual breathing training, and emotional support to help with the removal of the ventilator. Discussion with the healthcare team for the treatment plan and active caring helped relieve the patient's anxiety and fear of disease, assisted the family's coping with the hopelessness, and built up confidence in the team. Assistance was provided to the family in coping with the anxiety of issues associated with tracheotomy care. This nursing article emphasizes the importance of supporting patients and family members with anxiety. A good therapeutic relationship with the patient may assist the patient and family in coping with a disease's developing process.