運用Duffy品質關懷模式照顧一位外籍新冠肺炎重症患者之加護護理經驗

Applying the Duffy’s Quality Caring Model in a Nursing Experience in Intensive Care Unit for a Foreign Patient with Severe COVID-19 Pneumonia

根據衛生福利部疾病管制署分析，新冠肺炎重症死亡率高達8成以上。語言差異加上生命健康受威脅，使外籍患者於住院時承受更大的壓力。本文探討一位外籍新冠肺炎重症患者之加護護理經驗，照顧期間自2021年7月25日至8月6日，筆者藉觀察、會談、身體評估及病歷查閱等方式收集資料，並運用整體性評估確認個案之健康問題有：氣體交換功能障礙、體溫過高及焦慮。照顧過程運用Duffy品質關懷模式，藉「療癒環境」、「人類基本需求」、「獨特意義的人事物」、「鼓勵的方式」及「雙向問題解決」等品質關懷要素，透過主動關懷，與跨領域團隊合作，改善個案肺浸潤及呼吸衰竭，成功脫離呼吸器；按發燒的分期提供照護，配合醫療處置，增進個案舒適及維持體溫穩定；透過溝通板及翻譯軟體，讓個案表達感受與澄清疑問，配合院牧部及國際醫療中心資源轉介，提供靈性寄託及聯繫到案男友寫信彼此鼓勵，緩解個案焦慮。因COVID-19為新興傳染病，建議未來可將重症患者常見之健康問題與處置納入加護病房常規教育訓練課程，並加強護理人員英文溝通能力，使加護單位護理人員更知道如何應對COVID-19照顧，增進外籍COVID-19重症患者之照護品質。

According to the analysis conducted by Centers for Disease Control, ROC, the mortality rate of severe COVID-19 pneumonia is over 80%. Language differences and threats to life and health cause more stress for foreign patients during hospitalization. The purpose of this article was to explore a nursing experience in intensive care unit for a foreign patient with severe COVID-19 pneumonia. From Jul. 25 to Aug. 6, 2021, data were collected through observation, interview, physical assessment, and chart review. Through holistic assessment, the major health problems identified included impaired gas exchange, hyperthermia, and anxiety. Applying Duffy’s quality caring model, quality care elements such as“healing environment”,“basic human needs”,“appreciation of unique meanings”,“encouraging manner”, and“mutual problem solving”were integrated into the caregiving process. Through active care and cooperation with a cross-disciplinary team, the patient’s pulmonary infiltration and respiratory failure was improved, and she successfully weaned from ventilator. Through nursing care based on the stages of fever and medical treatment, we promoted the patient’s comfort and stabilized her body temperature. Through the communication board and translation software, the patient was able to express her feelings and to clarify her doubts; through cooperation with the resource referral of the hospital pastoral department and the international medical center, we provided spiritual sustenance and enabled the patient to contact her boyfriend by letters to encourage each other, which relieved the patient’s anxiety. For COVID-19 pneumonia is an emerging infectious disease, it is suggested that in the future, health problems and treatment of severe COVID-19 pneumonia and English-speaking courses can be incorporated into the on-the- job training of nurses, to improve the COVID-19 pneumonia caring techniques of intensive care unit nurses and the quality of care for foreign patients with severe COVID-19 pneumonia.