一位重症未期病人其家屬選擇撤除維生醫療之照護經驗

A Nursing Experience of Caring for a Terminally Ill Patient with Withdrawal of Life-Sustaining Treatment

安寧緩和條例實施後，對於失去決策能力之重症末期病人，家屬得以撤除已給予之維生醫療。但在實務執行上常因醫療團隊對於疾病是否進入末期缺乏共識，且不知如何開啟討論死亡之議題，而少有類似撤除案例的探討。本文旨在探討一位嚴重腦傷病人其家屬選擇撤除維生醫療之照護經驗。護理期間為2015年7月19日至7月27日，藉由訪談、觀察等方式收集資料並運用Gordon十一項功能性健康型態評估模式為指引，確立護理問題有：一、潛在危險性廢用症候群與腦部手術後意識昏迷有關；、家庭決策者焦慮／與面臨家人健康危機有關、家屬預期性哀傷／與面對親人即將死亡有關等主要護理問題。經由提供個別性護理措施，降低因廢用症候群可能導致的皮膚受損或感染。而家庭決策者之焦慮與預期性哀傷的問題則透過彈性調整會客時間、主動提供病情、同理心陪伴、傾聽關懷等，並藉由宗教信仰力量及協同關懷師與牧師禱告，引導家屬面對個案即將死亡的事實，最終能說出心中感受並完成四道人生（道歉、道愛、道謝、道別）。期望藉由本篇照護經驗，提供醫療人員日後照護之參考。

Since the Hospice and Palliative Care Act took effect, the family members of incapacitated terminally ill patients have been allowed to decide to withdraw patients' life-sustaining treatments. However, few clinical cases with withdrawal of life-sustaining treatments have been probed due to the difficulty of reaching a consensus on a patient's terminal condition and the difficulty of bringing up an end-of-life care issue to family members for discussion. This article explores a nursing experience of caring for a patient with severe brain injury whose family members decided to withdraw the patient's life-sustaining treatments. The nursing period was from July 19 to 27, 2015. The data were collected through observation and interview. With Gordon's 11 Functional Health Patterns for assessment, three nursing problems were identified: potential risk for disuse syndrome due to loss of consciousness secondary to brain surgery, primary patient care decision maker anxiety, and anticipatory grief of family members. During the nursing care period, individualized care was provided to reduce the potential risk of skin breakdown or skin infection caused by disuse syndrome. The primary patient care decision maker's anxiety and family members' anticipatory grief were relieved through the author's companionship, empathetic caring, and authentic listening. The patient was allowed to have a flexible visiting hours and the family members were provided with the updates regarding the patient's condition. Religious belief with the prayers of the priest and the champion helped the family accept the fact that the patient was dying. The family members were guided to express their feelings about apology, love, gratitude, and farewell to the patient. This paper may be used as a reference for other nurses caring for patients with a similar condition.