運用Swanson關懷理論照顧一位慢性阻塞性肺疾病病人之加護經驗

Intensive Nursing Experience of Applying Swanson’s Caring Theory to a Patient with Chronic Obstructive Pulmonary Disease

本文描述一位慢性阻塞性肺疾病病人，因病情惡化而初次入住加護病房插管之護理經驗。個案除呼吸困難引發生理不適外，處於陌生環境及面對疾病變化的不確定感而產生焦慮，引發筆者探討之動機。護理期間為2021年5月2日至5月10日，經由觀察、會談、身體評估及查閱病歷等方式收集資料，透過生理、心理、社會與靈性進行評估，確立個案主要健康問題有：低效性呼吸型態、活動無耐力及焦慮。針對各健康問題，筆者運用Swanson關懷理論於護理措施規劃，建立良好的醫病關係，鼓勵個案分享內心感受，提供其個別化的呼吸訓練、肺部復健及漸進式的肢體運動，改善呼吸喘及活動耐力；減少環境刺激、提供音樂搭配呼吸技巧，緩解壓力及焦慮程度，另透過共同參與訓練計畫、家庭陪伴及宗教慰藉，幫助個案面對疾病衝擊時可有正向的態度，並順利拔管及轉出加護病房。藉此護理經驗分享，提供護理人員對於慢性阻塞性肺疾病病人之整體性照護參考。

This article describes the nursing experience of a patient with chronic obstructive pulmonary disease (COPD) who underwent first-time intubation due to acute exacerbation. In addition to experiencing physical discomfort from dyspnea, the patient reported anxiety related to being in an unfamiliar environment and uncertainty about his illness. These factors prompted a comprehensive nursing assessment. During the care period from May 2 to May 10, 2021, data were collected through observation, communication, physical assessment, and review of medical records. Using assessments across physical, psychological, social, and spiritual dimensions, the patient’s primary health problems were identified as ineffective breathing pattern, activity intolerance, and anxiety. Swanson’s Theory of Caring guided the establishment of a therapeutic nurse–patient relationship and encouraged expression of feelings. Individualized nursing interventions included pulmonary rehabilitation exercises to improve dyspnea and activity tolerance, environmental modifications to reduce stress, and relaxation techniques, including music-assisted breathing exercises, to alleviate anxiety. Collaboration with the patient, family involvement, and incorporation of his religious beliefs supported coping and fostered a positive attitude. These combined interventions facilitated successful extubation and transfer to the ward. This case highlights the importance of holistic, patient-centered care for critically ill COPD patients undergoing intubation. Incorporating physical, psychological, social, and spiritual interventions can enhance patient outcomes, reduce anxiety, and support successful recovery. This report may serve as a reference for nurses planning care for similar patients in clinical practice.