一位末期漸凍人之加護病房護理經驗

A Nursing Experience of a Terminal Patient with Amyotrophic Lateral Sclerosis in Intensive Care Unit

本文為一位74歲女性末期漸凍人個案，面對死亡與家屬分離哀傷的加護護理經驗。於2012年8月18日至9月13日，藉由觀察、傾聽、會談、身體評估及電訪，並運用Gordon十一項功能性健康評估行整體性護理評估，確認個案有呼吸道清除功能失效、舒適障礙及預期性哀傷之主要健康問題。護理過程中，依個案服用藥物之作用時間配合噘嘴及橫膈膜式呼吸運動；提供個別性護理，降低不適；請案夫錄講個案喜愛的故事，轉移注意力；運用語言及非語言溝通方式減輕預期性哀傷之影響。醫療團隊與家屬共同計劃返家時機，引導個案與家屬面對死亡過程並完成其遺願。願此照護經驗能與護理同仁分享。

This article described an intensive care nursing experience of a 74 year-old female patient with amyotrophic lateral sclerosis (ALS), as she faced death and grief from family separation. During the period from August 18^(th) to September 13^(th), 2012, we collected information through observation, listening, direct and telephone interviews, and physical assessment, and applied Gordon’s eleven functional health assessment to provide a holistic evaluation of the patient’s conditions. It was confirmed that the patient’s major health problems were ineffective airway clearance, impaired comfort, and anticipatory grief. In the nursing process, we added pout and diaphragmatic breathing exercise in concert with the duration of the administered drug; provided individualized care to reduce the patient’s discomfort; diverted her attention by playing her favorite stories prerecorded by her husband; mitigated the impact of anticipatory grief by using the verbal and non-verbal communication strategies. The medical team planned with the family on the time of discharge, allowing the patient to spend her last moments with her family, and guided her and her families to face death and to fulfill her final wishes. We hope this experience can serve as a reference to our nursing colleagues.