一位多重性創傷病人之加護照護經驗

Intensive Care Experience of A Patient with Multiple Trauma

本文為照護一位多重性創傷之加護照護經驗。筆者於2022年06月15日至2022年06月28日，運用Gordon十一項功能性健康模式進行整體性評估，發現個案有氣體交換障礙、疼痛及焦慮三個主要健康問題。照護期間以個案為中心採整體性照護並啟動跨團隊整合照護模式結合各職種人員共同擬定治療計畫，監測血液動力學並以醫師和呼吸治療師討論依個案狀況調整呼吸器訓練模式，協助個案脫離葉克膜及呼吸器。密切監測個案疼痛反應，並利用藥物和非藥物方式，適時給予止痛藥物，教導個案深呼吸、聆聽輕音樂轉移對疼痛之注意力。此外藉由相關的統合分析來緩解焦慮：採取音樂療法提供個案聆聽喜愛的音樂降低焦慮、透過視訊系統連繫與家人間的情感有益於疾病復原、運用芳香療法以薰衣草精油舒緩霜協助個案按摩，增加舒適度使其放鬆促進睡眠以減輕焦慮感。建議臨床上可建置多重性創傷衛教影片及自製圖卡，提早介入讓個案及家屬了解疾病進程及醫療團隊後續治療計劃。照護過程反思年輕個案在心理和社會層面面臨不同的挑戰，照護團隊可照會社工師或心理師的協助，以提供更全面的支持。期望藉此加護經驗分享，以提升多重性創傷病人於加護病房之照護品質。

This article describes the intensive care experience of a patient with multiple trauma. From June 15, 2022, to June 28, 2022, the author conducted a comprehensive assessment using Gordon's Eleven Functional Health Patterns and identified three major health issues: impaired gas exchange, pain, and anxiety. During the care period, a patient-centered holistic care approach was adopted, and an integrated care model involving a multidisciplinary team was initiated to develop a treatment plan. Hemodynamic monitoring was carried out, and adjustments to ventilator training were made in consultation with physicians and respiratory therapists to assist the patient in weaning off ECMO and the ventilator. Pain responses were closely monitored, and pain relief was provided using both pharmacological and non-pharmacological methods, including administering analgesics and teaching deep breathing exercises and listening to soft music to divert attention from pain. Additionally, anxiety was alleviated through relevant integrative therapies: music therapy was used to provide the patient with favorite music to reduce anxiety, a video system was used to maintain emotional connections with family members, benefiting recovery, and aromatherapy with lavender essential oil soothing cream was employed to massage the patient, increasing comfort, relaxation, and promoting sleep to reduce anxiety. It is recommended that educational videos and self-made picture cards about multiple trauma be created and introduced early on to help patients and their families understand the disease process and subsequent treatment plans. Reflecting on the care process, young patients face different psychological and social challenges, and the care team can consult social workers or psychologists to provide more comprehensive support. It is hoped that sharing this intensive care experience will enhance the quality of care for patients with multiple trauma in the intensive care unit.