一位慢性阻塞性肺疾病病人無力感之護理經驗

A Nurse’s Personal Experience in the Care of a Patient Feeling Powerless after Being Afflicted with Chronic Obstructive Pulmonary Disease

據世界衛生組織統計顯示，慢性阻塞性肺疾病(Chronic obstructive pulmonary disease，COPD)罹患率逐年上升，全世界盛行率為4~10%，此病症為不可逆且反覆發作之慢性疾病，病人常因無法治癒及反覆發作的特性，而陷入「消極－－不動－－失能－－無力」之惡性循環中，因此護理人員更應思考如何提供適切的護理指導，以促進自我健康照護行為，提昇病人生活品質。本文探討一位慢性阻塞性肺疾病病人之護理經驗，照護期間（98年4月30日至5月12日）以羅氏適應模式為評估架構，藉由觀察、會談、傾聽與身體評估，發現個案有呼吸道清除功能障礙、活動無耐力、睡眠型態紊亂及無力感等健康問題。護理過程中，除協助個案緩解生理不適外，更鼓勵表達身、心、社會各方面之壓力及自我感受，並提供疾病相關訊息，積極邀請家屬參與照護。透過重要親友的溝通交流，讓其感受被關愛及被需要的溫暖；藉由宗教支持及慰藉等措施，協助病人適應及面對疾病的變化，重新設立生活目標，肯定自我存在價值，降低其對疾病產生的無力感，期盼臨床護理人員運用專業角色及技巧如情緒支持、減輕身體不適、提供正確資訊等，促進病人及家屬的照護品質，並提昇人性化關懷於臨床護理實務之應用。

According to the statistics of the World Health Organization, the rate of chronic obstructive pulmonary disease (COPD) is getting higher each year, and the prevalence rate has ranged from 4 to 10 % worldwide Chronic obstructive pulmonary disease is a chronic disease with recurrent and irreversible characteristics, in which patients are consequently unable to get out of a vicious negative cycle: inactivity→disability→powerlessness. As a result, nurses should think about how to provide appropriate care and guidance in order to promote self-health care behaviors and improve the patient's quality of life. This article explores the nursing experience of caring for a chronic obstructive pulmonary disease patient from April 30 to May 12, 2009.Using Roy's adaptation model as a framework for evaluation, and utilizing observation, interviews, listening and physical assessment, the nurse clarified the patient’s health problems such as respiratory tract dysfunction, activity intolerance, sleep pattern disturbance and feelings of powerlessness. In addition to helping alleviate physical discomfort, the nurse should encourage physical, mental, and social responses to stress and feelings about the self. The nursing staff should be able to provide information about the disease and actively invite family participation. It is important to communicate with friends and relatives so that the patient can feel loved and needed. The support and solace obtained through religion and other measures can help patients adapt and change the face of the disease, re-establish life goals, assert the value of their existence, and reduce their feelings of powerlessness. Nurses should use their professional skills to provide emotional support, reduce physical discomfort, provide accurate information, promote quality of care for patients and their families, and enhance humanistic care in clinical nursing practice.