致命性心律不整導致猝死後裝置體內去顫器病人之調適歷程

The Adaptation to an Implantable Cardioverter Defibrillator in a Survivor of Sudden Death Due to Fatal Arrhythmia

本文主要在探討致命性心律不整導致猝死後，裝置體內去顫器病人之調適歷程。此個案是經歷猝死急救後存活者，在無充分時間心理準備下，迫切地決定裝置體內去顫器（implantablecardioverter defibrillator, ICD），導致個案不知如何應對，進而對植入的ICD產生排斥想法。筆者於2015年11月10日至11月19日照護期間，藉由深入訪談與臨床觀察進行資料收集，並將訪談撰寫成行為過程實錄，經過反覆閱讀內容與分析，發現個案面臨裝置ICD後的相關健康問題為：對ICD存在感到困惑、ICD植入後身體心像改變及日後生活的調適障礙。照護期間除了提供ICD自我照護的相關訊息與強化支持系統運作之外，以不批判態度瞭解個案裝置ICD後看法，藉由共同探索裝置ICD的意義，來解除ICD存在之困惑，並共同討論裝置ICD對其影響，促進個案重新審視自我價值及人生目標。同時，重新建立傷口外觀圖像，體認ICD存在價值，轉變ICD植入後身體心像，以協助個案將ICD裝置內化，進而降低裝置後的心理衝擊，最終達到對ICD的正向調適。冀望將此經驗提供日後臨床照護上之參考，並協助裝置ICD個案之調適。

The purpose of this article was to explore the adaptation to an implantable cardioverter defibrillator (ICD) of a survivor of sudden death due to fatal arrhythmia. Owing to medical urgency, the case patient, a woman, did not have sufficient time to get prepared mentally. Therefore, the case had difficulty coping and ultimately rejected the ICD device. During the period of hospital care (November 10th to 19th, 2015), in-depth interview and clinical observation were used to obtain information from the case. The interview was transcribed and analyzed by repeated reading. The analysis found the following major post-ICD-implantation-associated health problems: confusion about the necessity of ICD, changes in body image due to ICD device implantation, and maladaptation in post-ICD daily life. In addition to providing ICD-related information and to strengthening her support system, we explored with the case the meanings of the ICD device in order to resolve her confusion. In addition, we recognized her perception regarding the ICD device without judgement and discussed the impact on her body of having the ICD. Concurrently, we encouraged the case to re-examine her self-value and life goals. In addition, we reconstructed the picture of the appearance of wound and made her realized the merit of the ICD. In terms of broader application, we hope that patients may learn to understand the worth and meanings of the ICD device and to restore positive attitudes with regard to body image. Furthermore, these interventions help encourage patients to re-examine their self-worth and goals and to internalize the ICD device, thereby minimizing the psychological impact of implantation. Ultimately, this case adapted well to the ICD device. Finally, we hope to share this experience as a reference for improving quality of care. These results may specifically help sudden death survivors to adapt to ICD implantation.