成功脫離機械式換氣之概念分析

A Concept Analysis of Successful Weaning from Mechanical Ventilation

脫離機械式換氣代表著重症病人從機械式換氣到恢復自主呼吸的一種轉變過程（transition），如何成功脫離呼吸器以增進呼吸器依賴病患之照護品質，是臨床醫護人員的共同目標。文獻缺乏對「成功脫離機械式換氣」的概念分析，本文依據Walker及Avant（1995）所提出的概念分析方法從實證的客觀觀點及病人主觀經驗進行操作性定義，以確認此概念的鑑定性特徵，包括客觀的生理指標及主觀的心理指標，並舉出範例輔助說明，提供臨床實務工作者或研究者在討論病患的機械式換氣脫離成效上能有一個明確且可比較性的結果指標。期望能增進臨床護理人員對此概念的相同語言，有助於呼吸器脫離之相關研究概念間關係的連結。

The process of being weaned from mechanical ventilation is a stressful transition for critically ill patients who are taken off ventilation assistance and regain spontaneous breathing. Degree of weaning success is being increasingly used as an outcome indicator in clinical practice and lay literature. However, ”successful weaning” remains a largely undefined concept in nursing practice. Following the concept analysis framework of Walker and Avant (1995), any such analysis that targets development of an operational definition of successful weaning should focus on two distinct sets of indicators, namely objective physiological and subjective psychological. Listing defining attributes and developing a model case will accurately reflect underlying relationships between weaning concepts.