協助－位COVID-19確診後呼吸器依?病人出院準備之護理經驗

The Nursing Experience of Helping Post Acute COVID-19 Syndrome and Prolonged Mechanical Ventilation Patient Discharge

本文描述一位COVID-19確診後呼吸衰竭放置氣管內管的老年病人，多次呼吸器脫離訓練皆失敗，且因長期住院引起病人渴望返家想法，透過出院準備計劃協助其返家之護理經驗，照護期間為2023年1月13日至3月1日，透過直接照護、筆談、唇形、手勢、身體評估、查閱病歷資料等方式收集資料，並以生理、心理、社會及靈性四大層面進行整體性評估，確立護理問題為：低效性呼吸型態、自我照顧能力缺失及增進家庭因應能力的準備度。病人因COVID-19所帶來的肺部病變及治療限制引起的肌力流失，導致長時間住院、反覆置入氣管內管甚至無法脫離呼吸器，故透過胸腔及肌力功能復健計畫，訓練病人呼吸肌肉力量與四肢肌肉力量，協助病人逐步進行呼吸器脫離訓練與恢復日常生活活動功能。而家屬因考量病人想返家之願望、住院已久且呼吸器困難脫離等情形，與醫療團隊討論後決定返家呼吸照護，透過出院準備計畫與跨團隊專業人員，提供家屬整體性照護知識與技巧，並進行回覆示教，最終協助病人成功銜接居家呼吸照護。建議往後照護相似病人時可以透過整體性評估，早期發現其護理問題並介入實證措施，除急性期照護外也需重視轉銜慢性照護之需求，盡早介入出院準備服務計劃，發揮全人乃至全家之照護精神。

This article describes a nursing experience for a post COVID-19 syndrome older patient with prolonged mechanical ventilation. Because of always failing ventilator weaning, the patient lives in hospital for few months and wants to go home. We help him back to home through discharge plan. From January 13th to March 1st, 2023, a nursing assessment was conducted through direct care, written communication, lip reading, gestures, physical assessments, and medical record reviews. A comprehensive assessment was conducted, identifying health problems: ineffective breathing pattern, self-care deficit, and readiness for enhance family coping. Muscle loss due to COVID-19 complications made ventilator withdrawal challenging. Rehabilitation focused on respiratory and limb strength to aid weaning and daily function recovery. Considering the patient's desire to return home, prolonged mechanical ventilation, the medical team and family decided to use the ventilator care at home. Through discharge planning and multidisciplinary professionals, we provide comprehensive care knowledge and skills to the family, offering reinforcement and demonstrations, ultimately aiding the patient's successful transition to home respiratory care. It's recommended that in caring for similar patients in the future, a comprehensive assessment should be conducted to identify health problems early and implement evidence-based measures. Besides acute care, it's important to consider the transition to chronic care needs. Early involvement in discharge planning services demonstrates a comprehensive care approach for both the patient and their family.