運用Swanson關懷理論照護一位慢性阻塞性肺病末期個案之護理經驗

A nursing Experience Based on Swanson's Caring Theory on a Patient with Terminal Chronic Obstructive Pulmonary Disease

本文為照護一位慢性阻塞性肺病末期個案，因不符合肺移植條件，伴隨呼吸喘症狀加劇，感受到死亡逐漸逼近，而對未來感到無望，故引發筆者探討之動機。照護期間自202 年 月2至日 月20日，針對生理、心理、社會、智能與靈性進行評估，確立個案主要健康問題有：低效性呼吸型態、營養不均衡：少於身體需要、無望感。運用Swanson關懷理論五大核心概念作架構，使個案闡述對疾病的感受，結合跨領域團隊完整照護計畫，循序漸進教導肺部復健計畫、擬訂個別化菜單、偕同安寧共照師介入，積極協商團隊開立家庭會議，鼓勵家人參與，回顧以往人生經歷，感受被愛與肯定自我價值。為提升護理措施之成效，促進主要照顧者對疾病的認知與居家照護技巧，共同擬定出院準備照護計畫，建議再由COPD個管師密切追蹤出院後狀況，達到連續性照顧。期望藉此個案照護經驗，提供臨床護理人員照護類似個案時之參酌。

This article described an experience of caring for a terminal Chronic Obstructive Pulmonary Disease patient who didn’t meet the requirements for lung transplantation with progressive dyspnea. It initiated the author’s motivation to discuss that the patient gradually approached death and felt hopeless about the future. The main health problems included ineffective breathing pattern, imbalanced nutrition: less than body requirement, and hopelessness which were assessed through physical, psychological, social, intellectual, and spiritual aspects from November 12 to November 20, 2021. Based on the five core conceptions of Swanson's caring theory, the patient described his feelings about the disease and we integrated a complete care plan by an interprofessional collaborative practice for him. Besides, we taught the patient and his caregiver about the pulmonary rehabilitation plan step by step and made a personal recipe. We also consulted hospice to hold a meeting that encouraged the patient and his family to express their feelings and review past life experiences together, helping them feel loved and assured of self-value. To make the care plan more effective, we promoted his caregiver’s knowledge and home care skills of COPD. Moreover, during hospitalization we made a discharge care plan along with the patient and his caregiver, after that we suggested a COPD case manager who is responsible for following the patient’s condition after discharge so that can achieve continuity of care. It is hoped that this nursing experience may provide medical staff with a reference in caring for such cases in the future.