協助一位單親媽媽接受葉克膜家庭調適之護理經驗

Experience of Assisting a Single Mother on ECMO Support and her Child in Coping with Crisis

本文探討一位單親媽媽因為心肌炎併發心因性休克而接受葉克膜治療，造成家庭調適紊亂問題，故引起筆者想協助其成功脫離葉克膜治療，以及協助家庭成員因應問題的動機。照護期間自2018年3月1日至3月10日，運用Gordon十一項功能性健康模式進行整體性評估，發現個案有心輸出量改變、急性疼痛、家庭因應能力失調及焦慮四個主要健康問題。護理過程以病人及家庭為中心提供照護，因心衰竭使用葉克膜增加心輸出量，密切監測生命徵象，提供葉克膜治療的正確資訊及術後照護說明，讓個案及家屬安心。筆者密切監測疼痛狀況，教導減輕疼痛技巧例如音樂治療，肢體按摩，再依需求調整姿勢臥位及管路擺位，減少管路及傷口拉扯。主動照會社工師、營養師等相關團隊，提供社會資源補助訊息，建立良好互信護病關係，鼓勵表達情緒感受，陪伴個案家庭因應這疾病過程的衝擊。提供家屬彈性會客、一對一示教等個別性及整體性、連續性的照顧支持，使個案及其家庭雙方減輕壓力，讓個案焦慮程度由23分降到12分。建議加護病房護理人員注重病人生理照護外，也積極降低病人與家屬的壓力與擔憂，提供轉出病房後續的照顧資訊，以促進病人與家屬因應與調適。

This article describes a single mother who received ECMO treatment due to myocarditis complicated by cardiogenic shock, which caused family adjustment disorders. Therefore, the author wanted to help her successfully wean ECMO therapy and help her family members cope with the problem. During the care period from March 1 to March 10, 2018, Gordon's eleven functional health patterns were used for overall assessment. It was found that the case had four major health problems: changes in cardiac output, acute pain, family coping ability imbalance, and anxiety. The nursing process centered on the patient and family to provide care. Because the use of ECMO in heart failure increased cardiac output, we closely monitored vital signs, provided correct information on ECMO treatment and post-operative care instructions, so that the patient and their families can feel at ease. We closely monitored the pain situation and taught pain relief techniques such as music therapy and limb massage. Then we adjusted the patient's position and tube position according to needs to reduce tubes and wound pulling. We consulted social workers, dietitians and other relevant teams to provide social resource on subsidy information and established a good mutual trust and nurse-patient relationship. We encouraged the patient to express her emotions and feelings, and accompany her families to cope with the impact of the disease process. We provide individual, holistic and continuous care support such as flexible visits to family members and one-on-one teaching. Therefore, the stress of both the case and the family was reduced, and the anxiety level of the case was reduced from 23 points to 12 points. It is recommended that the nursing staff in the intensive care unit not only pay attention to the physiological care of the patient, but also actively reduce the pressure and worries of the patient and their families. The follow-up care information after transfer to the ward should also be provided to facilitate the copping and adjustment of the patients and their families.