照護一位Guillain-Barré症候群病人無望感之護理經驗

Nursing Experience in Caring for a Hopeless Patient with Guillain-Barré Syndrome

本文敘述一位罹患Guillain-Barré症候群的個案因肌肉無力進展至呼吸衰竭，而喪失自我控制能力，於加護病房進行呼吸器脫離訓練期間出現無望感及死亡意念的護理經驗。護理期間為101年6月13日至6月25日，經由直接照護、身體評估、會談、觀察與家庭互動等方式收集資料，以Gordon十一項健康功能型態評估分析確立個案主要護理問題為：呼吸道清除功能失效、身體活動功能障礙、排便型態改變、無望感。筆者運用護理的獨立性功能、正視疾病進展及提供相關醫療訊息並透過跨團隊合作與家屬討論治療方向，強化家庭支持系統，使其情緒能得到適當的宣洩，減輕對疾病的焦慮及害怕，積極增進個案的肌肉力量及進行呼吸訓練，使個案對治療有正向態度，能主動表達感受，參與自我照顧活動，以提升個案的自我控制感，逐步接受罹病的事實，積極面對未來的治療與復健計畫。筆者將此經驗與護理同仁分享，供日後照護此類病人的參考。

This article is a case study of nursing experience with a patient who suffered muscle weakness, respiratory failure and the eventual loss of the ability for self-control as a result of Guillain- Barré syndrome. The patient appeared hopeless in the face of a near-death experience during ventilator weaning training in the ICU. During the period from June 13th through 25th 2012, information was collected by direct care, physical examination, interviews, and interaction with the family. Following Gordon’s 11 item Health Assessment, we identified the problems as ineffective airway clearance, impaired physical mobility, an altered pattern of defecation, and hopelessness. With independent professional skill and multidisciplinary team support, we discussed the treatment plan with the family, strengthened family support, and reduced the patient’s anxiety and fear. This also enhanced muscle strength and respiratory training so that the patient could actively express feelings and become more involved in self-care and the rehabilitation program.