協助一位頸椎損傷與呼吸器依賴病人返家照護之護理經驗

Nursing Experience in the Development of Home Care Strategy for Dealing with a Ventilator-Dependent Patient with a Cervical Spine Injury

本報告是敘述一位因車禍頸椎損傷，導致呼吸器依賴的68歲患者，協助其返家照護的護理經驗。筆者照護期間為2010年6月29日至9月13日，運用Gordon十一項功能性健康型態進行護理評估，歸納出病人有「呼吸道清除功能失效」、「身體活動功能障礙」、「無力感」等健康問題，以及照顧者在面對居家照護產生「照顧者角色緊張」之問題。於護理期間運用同理心、主動關懷、傾聽、陪伴等技巧，與個案及其主要照顧者建立良好護病關係，除提供個別性護理照護外，並針對個案返家照護之決定，聯繫呼吸治療師、營養師、復健師、藥師與出院準備護理師，透過跨團隊合作方式，提供病人與照顧者整體性照護知識與技巧，減輕照護上的緊張與焦慮，並與居家護理師進行交班，延續出院後的照護。使病人獲得良好照護，提升居家生活品質。

The article describes the nursing experience with a ventilator-dependent patient with a traffic accident-induced cervical spine injury. Gordon's 11 functional health patterns were utilized to evaluate the patient. Observation, assessment, and interviews with the patient and family were conducted from June 29th to September 13th, 2010. After a thorough evaluation, it was determined that the health problems which the patient faced included ineffective airway clearance, impaired physical mobility, powerlessness, and caregiver role strain. Individual nursing interventions using skills such as empathy, listening and accompaniment were provided. Health team workers including a respiratory therapist, dietitian, physiotherapist, pharmacist and case manager were contacted for holistic care and integrated nursing after the patient’s family decided to take the patient home. This strategy helped the patient’s family develop an adequate home-care plan for the patient, and this effectively improved the quality of care for the patient and the quality of life for the primary caregivers.