運用 Swanson關懷理論照顧一位慢性阻塞性肺病急性發作病人

Applying Swanson’s Caring Theory in the Care of a Patient with Acute Exacerbation of COPD

本文為一位84歲男性診斷慢性阻塞性肺病，因急性發作導致近期反覆住院個案。透過此個案照護經驗及運用Swanson關懷理論，提供臨床護理人員照護類似個案時之參考。照護期間為2023年09月06日至09月15日，以Gordon 11項健康功能型態進行整體評估，確立呼吸道清除功能失效、皮膚完整性受損、無望感為主要健康問題，護理過程將實證運用於照護中，結合Swanson關懷理論，以跨團隊合作進行個別性護理。教導振盪式呼氣正壓裝置（oscillatory positive expiratory pressure，OPEP），搭配有效咳嗽，並且運用Bronkotest 5-point chart客觀評估痰液顏色，使其痰液顏色等級下降，改善急性症狀；教導皮膚照護方法，與個案討論照護和復健計畫，增加對疾病的自我控制感，鼓勵表達內心感受，耐心和同理的傾聽，給予回饋與讚美，進而正向面對疾病進展。透過本篇護理經驗分享，筆者深刻體會除了專業醫療照護外，對於急性期住院的病人，給予心理上的支持也是相當重要的，鼓勵照顧者在旁陪伴，增進訓練成果，持續正向心態。

This article presents the case of an 84-year-old male diagnosed with chronic obstructive pulmonary disease (COPD), who experienced recurrent hospitalizations due to acute exacerbations. Through this case care experience and the application of Swanson’s Caring Theory, this report aims to provide clinical nursing staff with a reference for caring for patients with similar conditions.The care period was from September 6 to September 15, 2023. Using Gordon’s 11 Functional Health Patterns, a comprehensive assessment was conducted, identifying ineffective airway clearance, impaired skin integrity, and hopelessness as the main health problems. Evidence-based nursing interventions were implemented throughout the care process, integrating Swanson’s Caring Theory and individualized care through interdisciplinary collaboration. The patient was taught to use an oscillatory positive expiratory pressure (OPEP) device combined with effective coughing techniques. The Bronkotest 5-point chart was applied to objectively evaluate sputum color, which showed improvement in sputum grading and alleviation of acute symptoms. Skin care techniques were taught, and care and rehabilitation plans were discussed with the patient to enhance self-control over the disease. Emotional expression was encouraged, with empathetic listening, feedback, and positive reinforcement, helping the patient face disease progression with a more positive attitude. Through this nursing experience, the author deeply realized that, in addition to professional medical care, providing psychological support to patients hospitalized in the acute phase is equally essential. Encouraging caregivers to accompany the patient not only enhances rehabilitation outcomes but also fosters a sustained positive mindset.