運用Watson關懷理論照顧一位感染破傷風合併呼吸衰竭個案之加護經驗

Experience of Caring a Patient with Tetanus and Respiratory Failure Using Watson's Caring Theory

本文旨在描述一位72歲女性因感染破傷風引發呼吸衰竭之加護經驗。個案於感染破傷風後，隨即面臨病情惡化而入住加護病房。緊接而來的是因疾病導致肢體活動不便，需面臨長期復健的艱辛歷程，而引起其內心極大的衝擊，使得個案產生不安、焦慮等情緒。另外，其家屬在面對個案病情突如其來的劇變，不僅慌張失措，更對疾病日後照顧產生許多壓力。筆者於加護病房照護期間，運用Watson關懷理論為架構，確立個案的護理問題有呼吸道清除功能失效、身體活動功能障礙及焦慮等護理問題。護理期間針對個案及家屬的問題及需求，提供個別性及獨特性之護理措施，包括：教導個案深呼吸咳嗽及腹式呼吸技巧，使之順利協助排出痰液；實際讓家屬參與照護計畫，協助個案執行胸腔物理治療及關節復健運動技巧；教導個案深呼吸放鬆及讓家屬以按摩緩解個案焦慮情形。除此之外，適時提供家屬疾病資訊及相關資源，以增進其對於疾病的認知與減少不安感。另外，運用團隊資源管理概念，建立照護團隊，協助個案渡過疾病危險期。除此之外，運用3C電子產品使無法以言語表達之病人，順利溝通表達，藉由治療關係的逐步建立，鼓勵個案正向面對疾病與調適，增進其信心，提供完整之身心靈照護。 This case report detailed the experience of caring for a 72-year-old woman who had respiratory failure due to tetanus infection. The patient was admitted to the intensive care unit (ICU) soon after her tetanus infection. Diseaseinduced restrictions on physical mobility ensued, subjecting the patient to a challenging process of long-term rehabilitation. This had a substantial impact on the patient´s psychological state and induced distress and anxiety. The patient's family members panicked when faced with the sudden and drastic change, and were considerably stressed about the subsequent caring for the patient. During the patient's stay in the ICU, the authors adopted Watson's caring theory as a framework, and identifying nursing problems, including ineffective airway clearance, impaired physical mobility, and anxiety. The authors provided individualized and tailored care measures in response to the patient's and her family members´ problems and needs, included teaching the skills of deep breathing, coughing, and abdominal breathing to assist her to clear the phlegm; incorporating the family members in the care plan to aid the patient in conducting chest physical therapy and joint rehabilitation; and guiding the patient to relax through deep breathing and instructing her family members to mitigate her anxiety through massage. In addition, the author provided related information and resources to enhance their knowledge and to reduce their anxiety. The concept of team resource management was also employed to assist the patient in safely handling the critical phase of the disease. Consumer electronic devices were also used to help the patient, who could not speak well enough to express her thoughts. Overall, establishing a positive therapeutic relationship can encourage patients to face their diseases with a positive attitude, adapt themselves to the disease conditions, and increase their self-confidence. This facilitates creating a comprehensive care scheme that caters to the patients´ physical and psychological needs.