一位腦損傷產婦其家屬撤除維生醫療照護經驗

The Nursing Experience of Caring for a Serious Brain Injury Patient with Withdrawal of Life-Sustaining Treatment

本文描述一位產後因子癇症造成嚴重腦損傷病人，歷經手術及一連串積極治療後，仍無法脫離呼吸器，疾病進展不可逆，家屬在長期照護及撤除維生醫療間兩難的決策過程。照護期間為2017年3月20日至4月18日，筆者透過直接照護、觀察及家屬會談進行資料收集，以紐曼系統模式進行評估，確立主要健康問題為潛在危險性感染、抉擇衝突、預期性哀傷等；提供完整撤除維生醫療資料，利用互動式表單釐清疑問，舉辦家庭會議，協助決策；預期性哀傷方面，同理哀傷，運用安寧療護理念，由藝術治療師協助全家執行手足模的製作，留下紀念，提供臨終照護資訊，降低抉擇衝突。護理過程中，深感護理人員對疾病末期關懷及如何利用團隊資源適切提供此類家庭照護的知識與能力不足，故建議產科病房可定期邀請醫療團隊成員，提供護理人員在職教育，提升照護此類個案的相關知識與照護技巧。

This paper described the nursing experience of caring for a patient with serious brain injury caused by postpartum eclampsia who failed to withdraw from a ventilator after undergoing surgery and a series of active treatments, leading to irreversible disease progression. The patient was about to entered the end-of-life stage. The family members faced decision dilemma of continuing long-term care or withdrawing from life-support medical treatment. The care period was from March 20th, 2017 to April 18th, 2017. The author collected data through direct care, observations, and interviews with the family members. An assessment was carried out using the Newman system model to establish the major health problems, including potentially dangerous infections, conflicts of choice, and anticipatory grief. To help resolve decisional conflict among family members, a complete life-sustaining medical treatment withdrawal information was provided, interactive forms were used to clarify questions, and family meetings were held to understand the ideas of each family member and assist in decision-making. To alleviate anticipatory grief, in addition to empathy, an art therapist was introduced to to assist the family produce hand and foot models for remembrance. During the nursing care process, we realized that nursing staff's knowledge and competency in providing end-stage care were inadequate. We managed to utilize team resources to appropriately provide such family care. Therefore, it is recommended that maternity wards regularly invite medical team members to provide in-service education to nurses in order to increase their knowledge of offering care to such patients and families, thereby improving the quality of care.