照顧一位外籍船員遭遇海難事故之護理經驗

The Nursing Experience of Aa Foreign Crew Suffered Shipwreck

本文探討一位26歲外籍印尼男性，為家中長子，從事船員工作，肩負家庭經濟重擔，此次因船隻遇暴風雨擱淺於外港，船身斷裂造成輪船漏油事件，個案從船上跳水逃生落入海中意識不清，送至急診因呼吸窘迫插管入加護病房治療，清醒後面臨語言不通及無法返回印尼與家人團聚，獨自面對於異國罹難後的心理衝擊。照護期間為2011年10月03日至2011年10月10日，以觀察、會談及紙筆溝通等方式收集資料，針對生理、心理、靈性及社會進行評估，顯示個案有氣體交換障礙、睡眠型態紊亂及焦慮等健康問題，運用Watson關懷理論，透過醫師、護理師、呼吸治療師等醫療團隊提供護理措施，包括每班聽診呼吸音、監測動脈血氧濃度；夜間睡覺時調整室內燈光及配合個案生活習慣於睡前口腔清潔；製作英文圖卡及簡單英文溝通，排除溝通上的問題、發展信賴關係引導說出海難情緒表達並提供個案返回祖國流程，給予個別性照護方式，著實解決氣體交換障礙、睡眠型態紊亂及焦慮等健康問題。最後個案於10月10日轉病房持續治療，透過電話訪談得知個案於病情穩定出院後即返回印尼，對於住院期間所提供之照護，內心充滿感激，期望此照顧經驗能與同儕分享，並作為日後照顧此類個案之參考。

This article reports the case of a 26-year-old Indonesian man who was in a shipwreck at an outport. The patient was the firstborn and main income earner of the family, working as a ship crew. In the accident, the ship was stranded in a foreign harbour during a storm, and its hull was fractured, causing an oil spill. The patient jumped off the ship and was found unconscious in the water. In the emergency department, he was intubated and then admitted to the intensive care unit. When he gained consciousness, he was confronted with a language barrier, the stress of being away from his home and family, and the psychological impact of the trauma. Nursing care was provided from October 3 to 10, 2011, and patient data collection included observation, conversation, and written communication. The patient’s physiological, psychological, spiritual, and sociological conditions were evaluated. The data showed that the patient exhibited impaired gas exchange, and sleep and anxiety disorders. In accordance with Watson’s caring theory, care was provided by a medical team that included physicians, nurses, and respiratory therapists, who monitored for auscultating breath sounds and arterial oxygen concentration during each shift; adjusted the indoor light during sleep time; facilitated the oral hygiene routine according to the patient’s habit; created English picture cards for simple communication to overcome the language barrier, building trust and guiding the patient to express feelings on the accident; and provided help with the process of returning to his home country. At the same time, an individualised nursing care was provided to help treat the impaired gas exchange, as well as the sleep and anxiety disorders. On October 10, the patient was transferred to the ward to continue treatment and then returned to Indonesia after his condition was stabilized. The patient was appreciative of all the care he received in the hospital. We would like to share this nursing care experience with peers in order to provide a reference in the future for similar cases.