運用陪伴概念，協助一位慢性病病人成功脫離呼吸器之照護經驗

The Nursing Experience of Using the Concept of Presence on Chronic Diseases Patient to Successful Weaning of Ventilation

本文運用陪伴概念協助慢性病病人成功脫離呼吸器之護理經驗，個案在心理壓力無法負荷之下，產生焦慮不安負面的身心反應，出現呼吸作功增加，致使呼吸器脫離訓練困難度提升，護理期間2019年2月20日至2019年4月1日，筆者運用Gordon十一項功能性健康型態評估，透過實際照護及病歷收集資料方式，確立主要的健康問題有潛在危險性皮膚完整性受損、焦慮、呼吸道清除功能失效。個案面對脫離呼吸器所產生的焦慮，運用陪伴、主動探視及持續性關懷病人，建立有效溝通方式，讓個案感受到「共在」的含意，主動分享內心想法，減輕焦慮並增加安全感，運用肢體語言、輕撫手背方式支持情緒，使個案對脫離呼吸器計劃保有正向的想法；了解個案不願意翻身的原因，並個別性教導主要照顧者及個案預防壓傷的方法及重要性，避免因皮膚破損導致身體預防感染的第一道防線失守；教導個案擴胸運動、雙上肢運動及雙下肢無負重抬腿運動，漸進式的肺部復健訓練，增加肌肉耐受力及提高強度，進而成功脫離呼吸器，提升護理措施的實質成效，降低其併發症的產生。建議將此陪伴概念納入單位核心教育課程，以資深護理師帶領新進護理師將此概念發揮最大價值。希望藉此經驗提供日後臨床照護此類病人之參考。

"The study describes a nursing experience of using the concept of presence on chronic diseases patient to successful weaning of ventilation. Under the psychological pressure, the case has a negative physical and mental reaction of anxiety, and the work of breathing has increased, which makes it more difficult for the ventilator to get out of training. The period of nursing care was from 2019/02/20 to 2019/04/01. It used Gordon 11-event functional health pattern assessment guide to evaluate patient’s needs. The patient suffered from potential risk for impaired skin integrity, anxiety, and ineffective airway clearance. In the face of anxiety caused by disconnecting from the ventilator, we established effective communication with companionship, establish effective communication methods so that the case can feel the meaning of ""coexistence"". We let the patient feel the meaning of ""being together"" and actively share inner thoughts to reduce anxiety and feel security. Use body language and hand touch the back to support the patient positive thoughts and emotions through the de-breather training. Educate the importance of pressure injury prevention and change position to caregivers and patients. Providing relevant nursing measures individuality to prevent pressure wounds occur. On the other hands, performing chest expansion exercises, upper limb exercises, lower limb weightless leg lifts to progressive pulmonary rehabilitation. It could enhance muscle tolerance, successful weaning of ventilator and reduce complications. The nursing experience could let the nurse know how to care patients through the concept of presence and support them."