一位溺水學童及其家屬之加護經驗

Nursing Experience of a Drowned Child and His Family in ICU

本文描述一位因溺水導致腦部缺氧變成植物人之國小學童，及協助主要照顧者面對突發事件衝擊壓力調適之加護經驗。護理期間為2013年5月9日至5月29日，藉由身體評估、直接照顧、觀察、會談及運用Gordon十一項健康功能型態評估個案與家屬，確立個案有呼吸道清除功能失效、潛在危險性腦組織灌流失效、體溫過高之護理問題；家屬則有哀傷問題。透過加護獨特性照護，成功維持個案生命機能、改善腦灌流與控制感染，避免腦部二度傷害；且在加護醫療團隊合作下，成功協助家屬渡過哀傷過程，接受患童成為植物人之事實。因此，建議於重症單位可成立家屬支持團體，加強家屬身心靈的輔導。並期望藉由此照護經驗教導主要照護者後續照護知識與技能，進而能以正向態度接受個案的病情進展，並作為臨床護理同仁照護之參考。

This case study described an ICU nursing experience of a child who suffered from hypoxic encephalopathy after being rescued from drowning, and the aid of caregivers to cope with the stress caused by the accident. From May 9^(th) to May 29^(th), 2013, the author applied clinical observation, primary nursing care, interviews and physical assessment as guided by the Gordon's 11 functional health patterns to identify the major health problems of both the patient and the caregiver. After assessment, four major nursing problems were diagnosed: effectual airway clearance, risk for ineffective cerebral tissue perfusion, hyperthermia, and caregiver grief. Through an individualized care, the author avoided secondary brain injury by maintaining the patient's vital functions, improving cerebral perfusion, and preventing infection. With the collaborative effort of the ICU medical team, we worked with the caregivers through the grieving process by providing empathy and mental support, and helped the caregivers to accept the fact that the child was in a vegetative state. It is recommended to facilitate a support group for critical care families that provides physical and mental support and counseling. With this nursing experience, we hope to equip primary caregivers with the knowledge and skills of continuous nursing care, which could assist them to accept their patients' disease progression with a positive mentality. It could also serves as a reference for clinical nursing staff when encountering similar cases in the future.