照顧一位到院前心跳停止個案之加護護理經驗

Nursing Experience for an Out-of-Hospital Cardiac Arrest (OHCA) Patient in the Intensive Care Unit

本文旨在描述一位到院前心跳停止經急救復甦恢復自發性循環個案，於加護病房接受低溫治療，經歷急救及死亡威脅，家屬產生焦慮反應之護理經驗。2016年10月27日至11月9日護理期間，藉由直接照顧、觀察、身體評估、家屬會談及病歷回顧等方式蒐集資料，針對個案生理、心理、社會及靈性層面進行整體性評估，確立個案有潛在性腦組織灌流失效、心輸出量減少與家屬焦慮等健康問題。護理過程期間，筆者協助執行低溫治療，降低腦細胞及心臟細胞受損程度；監測各項生理變化，減少低溫治療合併症及心律不整情形發生；並運用主動關懷、同理心、傾聽及個別護理指導，以減輕家屬面對個案死亡威脅引發之焦慮反應，最後個案恢復並順利出院。對家屬來說，除了擔憂個案狀況引起焦慮反應外，病房中機器警告聲響也會引起家屬擔憂狀態，故利用心理支持與良好的醫護關係來緩解家屬焦慮表現將更顯重要。藉此經驗分享，提供護理師日後照護此類病人之參考，進而提升復甦後照護品質。 This article describes the nursing care experience for an out-of-hospital cardiac arrest (OHCA) patient after resuscitation and recovery of spontaneous circulation, receiving targeted temperature management treatment in the intensive care unit with anxious family members. During the nursing care period between October 27^(th) and November 9^(th), 2016, data was collected through direct care, observations, physical assessments, family meetings and chart reviews, and comprehensive assessments of the physical, psychological, social and spiritual aspects were implemented. Three health problems were identified: potential insufficient brain perfusion, low cardiac output, and anxiety of family members. During the caring process, the nursing staff implemented targeted temperature management care to decrease injury to brain and cardiac cell, monitored physical parameters to decrease the complications of therapeutic hypothermia, including arrhythmia, and applied active caring, empathy, listening and individual instructions to relieve family anxiety in response to the possibility of the death of the patient. In addition to the patient's medical condition, the sounds and alarms from medical equipment caused further anxiety to the family, so mental support and fostering a positive relationship with medical staff significantly decreased family anxiety. Ultimately, the patient was discharged smoothly after their recovery. It is with hope that this nursing experience can be of use as a reference for nurses in caring for patients in similar conditions and enhance post-resuscitation care quality in the future.

This article describes the nursing care experience for an out-of-hospital cardiac arrest (OHCA) patient after resuscitation and recovery of spontaneous circulation, receiving targeted temperature management treatment in the intensive care unit with anxious family members. During the nursing care period between October 27^(th) and November 9^(th), 2016, data was collected through direct care, observations, physical assessments, family meetings and chart reviews, and comprehensive assessments of the physical, psychological, social and spiritual aspects were implemented. Three health problems were identified: potential insufficient brain perfusion, low cardiac output, and anxiety of family members. During the caring process, the nursing staff implemented targeted temperature management care to decrease injury to brain and cardiac cell, monitored physical parameters to decrease the complications of therapeutic hypothermia, including arrhythmia, and applied active caring, empathy, listening and individual instructions to relieve family anxiety in response to the possibility of the death of the patient. In addition to the patient's medical condition, the sounds and alarms from medical equipment caused further anxiety to the family, so mental support and fostering a positive relationship with medical staff significantly decreased family anxiety. Ultimately, the patient was discharged smoothly after their recovery. It is with hope that this nursing experience can be of use as a reference for nurses in caring for patients in similar conditions and enhance post-resuscitation care quality in the future.