協助初次使用呼吸器個案面對脫離呼吸器過程之護理經驗

A Nursing Experience of Assisting a Patient Weaning from Ventilator

本篇敘述一位個案因急性心肌梗塞合併呼吸衰竭而初次使用呼吸器和人工氣道，其因無法脫離呼吸器活動受限長達60天無法下床，身心倍受壓力與煎熬。筆者以Gordon十一項功能性健康型態為評估架構，確立健康問題有1.自主換氣失能、2.無力感、3.焦慮等。護理過程，除協助個案緩解生理不適外，運用傾聽、同理心引導個案表達其自我感受與其所承受心理、社會方面之壓力，並建立有效的支持系統。護理過程中提供疾病資訊並鼓勵病患家屬參與，使其感受到被愛與被需要。各種支持、安慰能幫助病患適應及面對病情、肯定自我存在價值、並能降低無力感與焦慮。最後，個案重拾信心使負向情緒得以改善，亦成功的脫離呼吸器。

The research presented a female patient with acute myocardial infarction complicated with respiratory failure and requiring an artificial airway and ventilator assistance for the first time. The ventilator-dependent patient remained bedridden up to 60 days, which resulted in tremendous physical and mental stress and torment. Using Gordon 11-item Functional Health Pattern Assessment, the author identified the patient's clinical problems: inability to sustain spontaneous ventilation, powerlessness, and anxiety. During the nursing process, in addition to assisting the patient to alleviate physical discomfort, the author also employed listening and empathy to encourage the patient to express personal emotions as well as psychological and social stress, and then to build an effective support system; the author also provided information on the disease and facilitated family participation, which allowed the patient to fell loved and needed. Any form of support and solace could help the patient to face and cope with the disease, recognize self-worth, and reduce powerlessness and anxiety. The patient eventually regained confidence, improved the negative emotions, and was successfully weaned from ventilator