照顧一位運動神經元疾病末期個案身心靈之護理經驗

The Nursing Experience of a Motor Neuron Disease Patient's Body and Soul

本文旨在探討一位罹患運動神經元疾病個案，面對疾病進展至末期出現呼吸困難症狀，所衍生的身體、心理、社會及靈性等問題之護理經驗。筆者於2011年1月11日至1月30日照護期間，藉由身體評估、會談及家庭會議等方式收集資料後，進行個案身、心、靈各層面需求評估，確立個案有低效性呼吸型態、無力感及死亡焦慮等健康問題。護理期間採團隊照護與個案及家屬建立良好治療性人際關係，透過主動關懷及家庭會議，讓個案與醫療團隊共同擬訂住院期間之照護計畫，針對呼吸困難方面，提供精油、音樂及穴位按摩等輔助療法，來緩解個案不適症狀。隨著疾病導致身體功能日漸退化，個案對生活缺乏控制力，而出現無力感及死亡焦慮之情緒，筆者採傾聽和同理技巧適時給予心理支持，並尊重個案內心感受，運用生命回顧協助個案肯定生命意義及自我價值感，透過病友團體定時關懷，陪伴個案及家屬一起面對病程變化，同時指導個案及家屬學習照護技巧，協助增進面對疾病的信心，並透過出院準備服務將個案轉介至呼吸照護居家護理所，完成個案返家心願，達到全人、全家、全程及全隊的最高照護品質，藉此個案護理經驗之分享，提供臨床護理同仁做為日後照顧類似個案之參考。

This paper explores the nursing experience of a patient who suffers from motor neuron disease. This patient is in terminal stage of motor neuron disease with the late symptom such as breathing difficulties. There are also physical, psychological, social and spiritual problems in this case. Our care period is from January 11th, 2011 to January 30th, 2011. After collecting patient’s information by physical assessment, interviews and family meetings, we found out some serious problems, including ineffective breathing pattern, general weakness, and anxiety of death. During admission, we held the teamwork system. By fully communicating with the patient and his family, we established a good, trustable relationship. The patient and the medical team are able to develop the care plan together during hospitalization especially in treating for difficulty in breathing. Other than modern medication, we also offered essential oils, music, and acupressure complementary therapies to relieve the patient’s symptoms. As the disease progress, the patient lost the control not only on his body, but also on his life. General weakness and anxiety mood of death also appeared. We adopted listening and empathy skills, gave him psychological support, and respected the patients' feelings. We helped the patient with life-affirming meaning and increased his self-worth by using life review. Patients group also visited the patient and his family periodically, helped them to face the progress of disease and learn the skills of enhancing the confidence of this patient to face the terminal time. In order to fulfill the patient’s wish, we had introduced this case to a respiratory home care system by the help of our Discharge Service Center. Even in terminal stage, he went back home smoothly with a portable respirator. We wish to share our clinical experiences to clinical nursing staffs about taking care of patients with motor neuron disease.