運用Watson關懷理論照護一位Cohen幼兒家屬面臨氣切醫療決策衝突的護理經驗

A Nurse’s Experience Providing Care to a Mother of a Toddler With Cohen’s Syndrome Facing Tracheostomy Decision-Making Conflict Using Watson’s Caring Theory

個案為1歲5個月診斷Cohen綜合症合併腦性麻痺的幼兒，自出生即在醫療場域中反覆住院及手術。此次住院期間，因氣管軟化、吞嚥與自咳能力差，經歷兩次急救，醫師建議接受氣管切開術，使案母面臨個案疾病對生命的威脅及照顧的負擔上，對氣切決策負擔著巨大的壓力。護理期間自2022年9月19日至12月6日，筆者透過於加護病房互動會談的行為過程紀錄、通訊軟體、院外訪視及病歷查閱等資料分析，確立主要護理問題為「決策衝突：氣管切開術之醫療決策」，並將此護理過程分為案母面臨氣切決策的（一）逃避期，（二）衝突期，及（三）決策後的因應期。以Watson關懷理論中的十項關懷因子做為核心，透過傾聽、一致性及同理心與案母建立互信關係，使筆者能夠了解其需求提供足夠的資訊，並藉由召開家庭會議促進溝通、結合安寧緩和醫療資源給予後續的照護支持，幫助其家庭找尋一個屬於他們生命的意義。

This case involved a 17-month-old toddler with Cohen’s syndrome and cerebral palsy who had experienced multiple hospitalizations and operations since birth. During hospitalization, the patient suffered from tracheomalacia and poor swallowing and coughing abilities and had experienced two cardiopulmonary resuscitation events, after which a tracheotomy was suggested. Decision-making regarding the tracheotomy placed the mother under tremendous pressure, who was facing both the life-threatening disease of her son and her burden of care. During the nursing care period from 19th September to 6th December 2022, the author identified the main nursing problem as“decision-conflict: decision-making in relation to tracheotomy procedure”and distinguished the nursing process into (1) escape period, (2) conflict period, and (3) coping period after decision-making. Adopting the ten carative factors in Watson’s Caring Theory as the core of her care approach, the author was able to establish a mutually trusting relationship with the mother and to understand her needs by means of listening, consistency, and empathy. This involved providing sufficient information and holding family meetings to facilitate communication in combination with palliative medical resources to provide follow-up care support as well as helping the family find meaning in their lives.