照護一位嚴重特殊傳染性肺炎併發急性呼吸窘迫群之加護經驗

Intensive Care Experience of a Patient with Severe Pneumonia with Novel Pathogens with ARDS

新型冠狀病毒的感染疫情爆發使得全球醫護人員面臨重大的挑戰。本文探討一位嚴重特殊傳染性肺炎併發急性呼吸窘迫症候群病人，家屬同時接受隔離而出現家庭功能因應問題之重症加護經驗。護理期間自2020 年2 月10 日至2 月26 日，運用Gordon 十一項功能性健康型態評估後確立健康問題有「氣體交換障礙」、「潛在危險性損傷」及「危害性家庭因應能力」等，護理過程中，提供整體性護理措施，使個案在使用體外循環維生系統期間無出現併發症，最後順利脫離體外循環維生系統。對於面對親屬重症及配合居家隔離的親屬，醫護團隊透過遠距通訊方式讓家屬掌握個案病況，傾聽家屬需求，並協助家屬處理病人個人用物準備，維持家庭基本因應與運作功能。本文建議醫院能編列電子無線聽診器及紅外線體溫槍等設備，以因應此類新興傳染病個案照護。另外，視訊會客時，醫護團隊不易進行家庭關懷，建議能協同有相關經驗的個案管理師協助居家隔離家屬家庭運作與關懷，充分展現全人、全家的照護精神，盼此護理經驗分享，能提供日後照護此類個案之參考。

The COVID-19 outbreak has posed tremendous challenges to health workers worldwide. The present study described the intensive nursing care experience of caring a patient with COVID-19 accompanied with acute respiratory distress syndrome and dealing with the adaption problems encountered by family members who were put on isolation concurrently. The nursing period was from February 10 to 26 in 2020. Gordon's 11 functional health patterns were used to evaluate the patient's health problems, which included impairment of gas exchange, potential risk of injury, and compromised family coping. In the nursing process, comprehensive nursing measures were provided to prevent complications due to use of the extracorporeal life support system and ensure successful weaning from the system. As the patient's family members, the medical team updated them with the patient's status and listened to their needs by means of remote communication. The team helped the family maintain basic family coping and functioning. We recommended that hospitals be equipped with devices, such as electronic wireless stethoscope and infrared thermometer, to facilitate caring patients with novel infectious diseases. Additionally, because the check-in video calls to the family can easily become common, we recommended that experienced case managers can be appointed to maintain family functioning and provide to families on isolation. Such practices can achieve holistic care for patients and their families. This nursing experience provides insights for nursing care of similar patients in the future.