照護一位初次罹患急性心肌梗塞年輕男性之急診護理經驗

Emergency Nursing Experience of a Young Male with First Time Acute Myocardial Infarction

本文探討一位年輕男性罹患急性心肌梗塞之急診護理經驗，因面對突如其來的重大疾病威脅，頓時無法接受，言談中不斷透露出對疾病治療的不安與焦慮，擔心自己的未來與成為家人的負擔，故引發撰寫之動機。護理期間為2019 年3 月21 日至2019 年3 月23 日，筆者藉由直接照護、身體評估、觀察、會談方式收集相關資料，運用Gordon 十一項健康功能型態為評估架構，進行主、客觀評估與分析，確立個案有「心輸出量減少」、「疼痛」及「焦慮」三項健康問題。在急診期間，除提供醫療照護穩定生命徵象，降低生理不適外，亦運用護理專業功能，透過傾聽及同理病人感受，引導個案表達內心的感受與焦慮，陪伴個案走過急診的急性照護期，用積極且正向的態度面對疾病接受治療，希冀藉此次護理經驗分享，能有助於急診護理同仁日後照顧類似個案參考。急性心肌梗塞緊急處置照護是急診護理師所應具備的能力，但在心理層面評估與溝通技巧應用卻是欠缺的，建議邀請心理師與營養師共同舉辦跨團隊教育訓練課程，加強急診護理師心理評估、關懷技巧應用及飲食衛教指導，以增進護理師的洞察辨識力，對個案伸出溫暖的援手，引導表達心中感受，提供適切護理照護與衛教指導，進而提升照護品質，以達到全人照護。

"This article discussed the emergency nursing experience of caring a young man suffering from acute myocardial infarction. Because of the unexpected threat of the critical disease which was unacceptable, the man constantly revealed his worry and anxiety about the treatment during the conversation. Also, he worried about his future and becoming the burden of his family. The nursing period was from March 21 to 23, 2019. The author collected relevant data by direct care, physical assessment, observation, and interviews. We used Gordon's 11 Function Health Patterns as the evaluative framework to analyze subjective and objective assessment, and to confirm that the patient had three health problems: 'Decreased cardiac output', 'Pain', and 'Anxiety'. In the emergency department, in addition to providing medical care to stabilize vital signs and reduce physical discomfort, the nursing profession encouraged patients to state their feelings and anxiety through listening and empathy. We accompanied the patient through the acute phase of disease in the emergency department, allowing him face the disease and receive treatment with an active and positive attitude. In addition to critical care of acute myocardial infarction, nursing staff in emergent department should also possess evaluation and communication skills. It is recommended to invite psychologists and nutritionists to participate in interprofessional training courses to reinforce the abilities of psychological evaluation, application of caring skills, and dietary health education. With all these, we aim to provide optimal nursing care and health education to improve the quality of care and to achieve the goal of holistic health care."