協助病人成功脫離呼吸器順利返家之護理經驗

The Nursing Experience of Successfully Helping a Patient Weaning from Mechanical Ventilator

本文描述協助一位長期使用呼吸器病人首次面對脫離呼吸器訓練之過程，及主要照顧者面臨出院準備感到緊張、焦慮之護理經驗。護理期間2015年5月1日至6月6日，應用Gordon十一項功能性健康型態進行整體性評估收集資料，確立護理問題有（1）焦慮（2）照顧者角色緊張（3）呼吸機戒斷反應功能失常。護理過程中，醫療團隊擬訂脫離呼吸器計劃，透過適切的護理活動執行，家庭成員的陪伴，護理人員持續性主動關懷，建立治療性人際關係，建議及協助家屬製作利用簡易圖卡及字卡以了解病人需求，提供有效溝通方式，利用語言鼓勵不斷增強動機使個案對脫離呼吸器計劃保有正向的態度，鼓勵表達心裡感受，減少訓練期間產生的負向情緒表現，協助個案脫離呼吸器成功。主動協助主要照顧者面對個案出院後的照護問題，應與主要照顧者訂定照護學習計畫，依個別性採漸進式的教學及回覆示教的方法教導居家照護技能，降低其緊張情緒，使病人出院後得到完善的照護，落實出院準備計劃，如期讓個案返家休養，筆者期望將此護理經驗與同仁分享，能提供日後臨床護理同仁照護此類病人之參考。 This report described the process of helping a patient with long-term ventilator assistance weaning from mechanical ventilator and the experience of caregiver that being nervous and anxious about discharge preparation. During the nursing period from May 1st to June 6th, 2015, Gordon 11 functional health patterns was used to assess the nursing process, three major problems were identified: (1) anxiety of patient (2) tension of caregiver (3) dysfunction of weaning from the ventilator. During the nursing process, the medical team develops a plan for weaning from ventilator includes the appropriate nursing care, the companion of family members, the continuous care of caregivers, the establishment of therapeutic interpersonal relationships and effective communication. We also encouraged the patient to maintain a positive attitude for weaning program and reduced negative emotion during weaning program by talking to the patient. In order to assist the caregiver to face the care of the patients after discharge, we proactively set up a care program of home care skills for the caregiver individually to reduce their nervousness by tailored teaching schedule. The aim is to implement the discharge plan as scheduled and to provide the comprehensive care of the patient after discharge. By sharing this nursing experience, the author hopes to provide the experience for colleagues for the future clinical nursing process for such patients.