內科加護病房譫妄病人家屬之調適經驗

The Adaptation Experience of Family Members of Delirium Patients in the Intensive Care Unit

加護病房因環境及疾病因素使病人容易發生譫妄症狀，而譫妄症狀對於家屬而言是一大挑戰。本研究目的為了解內科加護病房譫妄病人家屬之調適經驗及感受，以質性研究個案深入訪談法，訪談台灣北部某醫學中心20位內科加護病房譫妄病人家屬。以Miles和Huberman（1994）提出之質性資料分析法進行資料分析。研究結果發現：內科加護病房譫妄病人家屬之調適經驗核心概念為啟動導航求生系統。家屬面對譫妄病人之症狀，如同在未知大海航域中啟動導航求生系統，採取之調適因應策略包括：自我導航定位、家庭生活與角色定位、尋求資源。並開闢新航道，嘗試以合適溝通方式及學習新照顧技巧，以渡過加護病房病人譫妄之發生歷程。針對此結果建議：可提供正念減壓課程，提升譫妄病人家屬自我導航定位之能力；因應加護病房有限訪視時間，建議可提供多元資訊化，將譫妄照護內容利用智慧手機結合掃描APP或製成QR Code，提供完整持續性照護資源。此外，建議護理人員可協助家屬運用多元溝通技巧及輔助工具，以了解病人所需，減少家屬因溝通不良挫折、不安、焦慮及減輕照顧負荷。

Delirium is a common disorder in the intensive care unit (ICU). Both ICU environment and acute illness have been associated with increased risk of delirium in the ICU wards, which in turn poses great challenge to the family members of delirium patients. The aim of our study is to understand the experiences of family members caring for ICU patients with delirium. Semi-structured qualitative interviews were conducted with 20 family members of patients with delirium in the ICU from a hospital in northern Taiwan. Data analysis based on the qualitative research analysis proposed by Miles and Huberman (1994). Results showed that most family members had feelings of helplessness and found the need to seek help. Family members attempted to overcome the challenges faced through understanding their role as a caregiver, seeking appropriate resources, and trying new yet appropriate communication and caring techniques. Our results suggested the need to educate family caregivers on stress relief techniques in order to maintain their mental well-being. In addition, as family members often search for caregiving-related information, we highly suggest the provision of information regarding caring for delirium patients on websites of ICU wards. By linking a QR code to the APP, information access can be enhanced as patients are able to obtain information by merely scanning the QR code. In addition, it is recommended that nursing staff can teach caregivers use multiple communication skills and supporting tools to understand the needs of patients and reduce family members' poor communication and anxiety, reducing the care load.