照護一位COVID-19重症個案住負壓智慧病房之經驗

Experience of Caring for a Critically Ill COVID-19 Patient in a Negative Pressure

本報告旨在分享一位確診為COVID-19重症個案入住負壓智慧病房接受治療的護理經驗。該病患因感染導致呼吸衰竭，需插管並接受呼吸器治療。其病程除引發氣體交換障礙與感染風險外，隔離治療與對疾病的不確定性亦造成明顯的焦慮與情緒困擾，身心狀況備受煎熬，並伴隨對疾病的恐懼與不安。本案護理期間自2022年2月17日至3月1日，透過直接照護、肢體語言溝通、觀察、筆談、身體評估及查閱病歷等方式進行整體性資料蒐集與評估，確認病患主要健康問題為氣體交換障礙、感染風險及焦慮情緒。護理過程中，筆者運用高頻震波拍痰器協助排痰，結合呼吸器相關性肺炎之預防性組合式照護措施，以維持呼吸道通暢。同時，藉由人性關懷、放鬆技巧及正向語言鼓勵，增強病患自信心，並安排視訊會客以促進病患與家屬間的情感連結。最終於3月1日順利解除隔離，轉出負壓病房。本經驗建議未來可導入智慧穿戴式醫療評估工具，以更精準掌握確診個案病情變化，並結合QR Code技術提供視訊衛教或預錄衛教影片，強化出院後之持續性照護計畫，期能作為臨床COVID-19重症照護之參考。

This case report presents the nursing experience of caring for a critically ill patient diagnosed with COVID-19, who was admitted to a negative pressure smart ward for treatment. The patient developed respiratory failure requiring endotracheal intubation and mechanical ventilation. In addition to impaired gas exchange and infection risk, the patient suffered significant psychological distress due to isolation and uncertainty about the illness, manifesting as severe anxiety and fear. The care period spanned from February 17 to March 1, 2022. Comprehensive assessment was conducted through direct care, non-verbal communication, observation, written dialogue, physical examination, and chart review. The primary health problems identif -ied were impaired gas exchange, risk of infection, and anxiety.Interventions included the use of a high-frequency chest wall oscillation device to facilitate sputum clearance, along with a ventilator-associated pneumonia prevention bundle to maintain airway patency. Psychosocial care focused on humanistic support, relaxation techniques, and verbal encouragement to enhance patient confidence. Video calls were arranged to maintain the patient's connection with family members. On March 1, the patient was successfully discharged from isolation and transferred to a general ward.This experience highlights the potential benefits of incorporating wearable smart medical devices for real-time patient monitoring. Additionally, integrating QR codes for access to video-based health education may strengthen continuity of care after discharge. These strategies offer valuable insights for clinical care of critically ill patients with COVID-19.