一位服藥自殺青少年個案之急診護理經驗

A Nursing Experience of Caring for a Patient who Attempted Suicide

本文描述一位17歲青少年因無法承受家庭、課業及同儕間壓力而服34顆Depakene自殺之急診護理經驗。2009年5月1、2日於急診護理期間以直接護理、觀察及會談方式收集資料，並以生理、心理、社會及靈性四方面進行評估，確立個案護理問題為潛在危險性中毒、焦慮及個人因應能力失調。透過大量輸液促進體內藥物排除，緊急進行血液透析，改善藥物中毒問題;清楚說明治療及處置目的、過程，減輕焦慮；病況穩定後運用傾聽、同理心技巧，引導及鼓勵個案說出自殺原因、想法與感受，並轉介心理諮詢、精神、社政專家等，使個案未因此次服藥過量造成身體傷害，更在個案自己、家層與醫療團隊共同努力下，主動表示願意重新面對狂言獲救後的人生。透過本個案照護經驗分享，期盼急診護理人員照護自殺病患時，除了緊急救護及處理生理問題外，更能兼具潛在心理、社會問題之協助，讓急診護理更具整體更臻完善。

This study describes nursing experience of caring for a 17 year- old male patient who attempted suicide. The patient took 34 tablets of depakene due to overloaded stress from family burdens, schoolwork, and peer pressure. Data were collected during nursing care in the emergency department from May 1 to May 2, 2009. Through a physical examination, observation, and an interview, the author assessed the patient's physiological, psychosocial, and spiritual needs. Identified major nursing problems included danger of potential drug intoxication, anxiety, and inability to cope. For drug intoxication, the patient received large amounts of hydration via an intravenous route, and an emergent hemodialysis was arranged to clear out residual amounts of the drug in his body. To relieve the patient's anxiety, the author clearly explained the purpose of all treatment procedures. Once his condition was stabilized, the patient was encouraged to share his thoughts and feelings about the suicide attempt. The patient was referred to the psychological counselor, the psychiatrist, and the social worker for follow up. With assistance from family members and the care team, the patient did not harm himself from the event, and he was willing to face a new life after-rescue. The purpose of this article is to demonstrate how emergency nurses cannot only focus on a patient's physical problems, but must also pay attention to the patient's psychological and social needs for the integrity of emergent nursing care.