照顧一位確診嚴重特殊傳染性肺炎聽障人士之護理經驗

Nursing Experience Caring for a COVID-19 Patient With Hearing Loss

本文描述一位境外感染新型冠狀病毒確診為嚴重特殊傳染性肺炎聽障個案，除了個案要面對傳染性疾病被隔離的情境與輸注新藥的不安外，也考驗醫護人員如何與其有效溝通。筆者於2020年3月14日至4月13日護理期間運用羅氏適應模式進行評估，確立個案健康問題有因罹患嚴重特殊傳染性肺炎導致低效性呼吸型態，因聽障導致與醫護人員間有言辭溝通障礙，另外因隔離治療及溝通障礙導致社交隔離。護理過程協助個案進行抗病毒藥物治療，教導個案採舒適坐臥及使用腹式呼吸改善低效性呼吸型態；運用自製字卡、提供紙筆與手機通訊軟體，提高個案與醫護人員間溝通的效能；使用紙筆交流並向其學習簡單手語，增進與個案的互動，使其適應隔離治療並配合後續治療，達成整體性的照護。藉此護理經驗建議醫院可與手語翻譯組織合作，提供醫護人員學習簡單的溝通技巧包含手語或圖卡等，以利日後提供給住院聽障人士更加完善的照護。

The focus of this article is on a male patient with hearing loss who was diagnosed with COVID-19 after returning to Taiwan from overseas. Due to the severe pneumonia infiltration, the patient received the clinical-trial treatment Remdesivir. In addition to facing the isolation and new-drug-related anxieties of the patient, the medical team faced difficulties in communicating effectively with the patient and in helping him through the isolation period. During the period of hospitalization (March 14th to April 13th, 2020), the author used Roy's adaptation model to perform a nursing assessment, which confirmed that the patient faced the following problems: (1) ineffective breathing pattern related to COVID-19, (2) impaired verbal communication related to hearing impairment, and (3) social isolation related to the isolation experience and the communication barrier with healthcare workers. During the nursing care process, the author helped the patient receive the antiviral treatment and taught him how to do diaphragmatic breathing in a comfortable, recumbent position to improve his breathing pattern. To reduce the difficulty of communication, the author made a pile of cards with common care-related words, provided pen and paper to write, and used a mobile-phone-based social-networking application to communicate with the patient. The author used writing to communicate with the patient and learned some simple signs from him to enable interaction. Moreover, the intervention helped him adapt to the isolation and treatment protocols to reach holistic nursing care. Based on this experience, the author suggests that hospitals cooperate with sign language organizations to teach healthcare workers simple communication skills, including sign language and cards to provide more complete care for patients with hearing loss during hospitalization.