運用重症生命末期整合照護模式照顧一位流感病人之加護經驗

The Nursing Experience of a Patient Diagnosed with Influenza in the Intensive Care Unit by Utilizing the End-of-Life Integrated Care Model

當死亡已不可避免時，重症末期整合護理照護模式可能成為最佳的醫療選擇。本文描述一位流感重症個案腦部出血後意識昏迷導致須依賴維生系統之照護經驗。遭遇突如其來的打擊，使家屬心力交瘁無法思考後續治療目標。家屬面臨選擇積極搶救或是不施行心肺復甦術，甚至撤除維生系統。在兩難之下產生醫療決策壓力，引發筆者之收案動機。照護期間自2016年2月22日至3月9日，運用「重症生命末期整合護理照護模式」概念，依據警覺期、溝通期、陪伴期、靈陪期等不同階段提供護理措施。在醫療團隊合作下，運用醫病共享決策理念讓家屬充分理解醫療極限，與家屬共同決策醫療目標。過程中，全程陪伴家屬並引導善終過程及介入靈性照護，同時給予哀傷支持以降低家屬遺憾；共同為生命最後一程減少無效醫療傷害，讓病人有尊嚴達到「善終」。建議透過教育積極推動重症安寧概念，推廣重症生命末期整合照護模式，可達全人護理之理想。

When the death is inevitable, providing the end-of-life integrated care model might be the best choice. This article describes the nursing experience of a patient diagnosed with severe complicated influenza and brain hemorrhage. Encountering the unexpected adversity, family members felt exhausted and could not decide the goal of treatment. The dilemma of making choice between aggressive treatment and do-not-resuscitate or withdrawing life support inspired the authors to intervene. From February 23 to March 9, 2016, authors utilized the concept of end-of-life integrated care model and provided nursing interventions through phases of awareness, communication, companionship, and spirit accompany. With the collaboration of the medical team, sharing decision-making could allow family members to fully understand the limitation of medical treatment and achieve mutual consensus of treatment goal. Nursing interventions included accompanying with all family members, facilitating peaceful death and spiritual care, and giving support to reduce bereavement and regretful feeling. In the end, the patient peacefully passed away with dignity, without suffering from medical futility. It is recommended to actively promote hospice care and the end-of-life integrated care model in the intensive care unit to accomplish the ideal of Holistic Health Care.