愛滋帶原者感染新型冠狀病毒之心理健康照護經驗

Experience Providing Psychological Care to an HIV-Positive Patient With SARS-CoV-2 Infection

10.6224/JN.202210_69(5).14

葉芝佑(Chih-Yu YEH)；葉乙臻(Yi-Chen YEH)；潘玫燕(Mei-Yan PAN)；劉秀雲(Hsiu-Yun LIU)

新型冠狀病毒 ； 愛滋 ； 去汙名化 ； 情境性低自尊 ； COVID-19 ； HIV/AIDS ； destigmatization ； situational low self-esteem

護理雜誌

69卷5期（2022 / 10 / 01）

120 - 126

繁體中文

傳染性疾病擁有高度被烙印及入罪化之特性。本文敘述愛滋帶原者合併感染新型冠狀病毒之照護經驗。文中個案因確診感染新型冠狀病毒入院隔離，害怕使愛滋帶原者身分曝光且對於自己染疫後將新型冠狀病毒傳染給同住母親感到自責，罹病後懊悔不已，亟需護理介入支持。護理期間自2021年7月15日至7月29日，筆者利用面對面及監視器觀察、身體評估、電話會談及醫療團隊討論之方式進行生理、心理、靈性及社會四大層面之評估，確立個案有現存性感染、焦慮及情境性低自尊之健康問題。於照護過程中提供新興傳染性疾病個人衛生指導，並按時給予服用組合型抗病毒藥物以維持免疫力；護理人員作為個案唯一直接接觸對象，藉由建立信賴關係，關懷傾聽個案對於雙重感染者身分的擔憂，同理並保證其隱私權，接納其於隔離期間的負面感受，強化支持系統幫助渡過隔離期之心理壓力。此照護經驗顯示為傳染性疾病病人提供心理照護之重要性，建議政府與媒體能提供正確資訊以強化社會大眾對傳染性疾病的認識與了解，達到去除污名，創造更友善醫療環境。

Infectious diseases are often stigmatized and criminalized because of the way they are transmitted. An experience providing care to a 37-year-old patient with human immunodeficiency virus (HIV) infection who was admitted to a medical center's quarantine ward in July 2021 due to SARS-CoV-2 infection is described in this article. This patient lived with his mother, who was later diagnosed with COVID-19 as well. He was worried about his mother's health condition and, meanwhile, feared that information about his diseases and person would be exposed by the media. These stressors led to increased feelings of shame and anxiety and to situational low self-esteem. Several interventions were provided, including education regarding the importance of personal hygiene and of maintaining combination antiretroviral therapy (cART) to bolster immune system functions. During the isolation period, the nurses most regularly interacted with the patient directly. Thus, we worked to build the nurse-patient relationship by listening to the patient's worries, guaranteeing his privacy would not be compromised, and guiding him to express his emotions to reduce anxiety and enhance confidence. This experience demonstrated the importance of providing psychological care to COVID-19/HIV co-infected patients. We suggest that the government and media distribute correct and neutral information to destigmatize communicable diseases and to foster a friendlier healthcare environment.

1. 張正學, C.-H.,鍾道詮, D.-C.(2016)。陪他走一段路：愛滋感染者申訴歷程的觀察與反思。東吳社會工作學報，31，149-167。
   連結：
2. 張正學, C.-H.,鍾道詮, D.-C.(2016)。陪他走一段路：愛滋感染者申訴歷程的觀察與反思。東吳社會工作學報，31，149-167。
   連結：
3. Avert Global HIV and AIDS Organization. (2022, March 18). Be in the KNOW website - HIV and COVID-19. https://www.avert.org/coronavirus/covid19-HIV
4. Brooks, S. K.,Webster, R. K.,Smith, L. E.,Woodland, L.,Wessely, S.,Greenberg, N.,Rubin, G. J.(2020).The psychological impact of quarantine and how to reduce it: Rapid review of the evidence.The Lancet,395(10227),912-920.
5. Cascella, M., Rajnik, M., Aleem, A., Dulebohn, S. C., & Di Napoli, R. (2022, February 5). Features, evaluation and treatment coronavirus (COVID-19). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554776/
6. Gatechompol, S.,Avihingsanon, A.,Putcharoen, O.,Ruxrungtham, K.,Kuritzkes, D. R.(2021).COVID-19 and HIV infection co-pandemics and their impact: A review of the literature.AIDS Research and Therapy,18(1),Article 28.
7. Hall, A.,Joseph, O.,Devlin, S.,Kerman, J.,Schmitt, J.,Ridgway, J. P.,McNulty, M. C.(2021)."That same stigma... that same hatred and negativity:" A qualitative study to understand stigma and medical mistrust experienced by people living with HIV diagnosed with COVID-19.BioMed Central Infectious Diseases,21(1),Article 1066.
8. Hoare, C. H.(2005).Erikson’s general and adult developmental revisions of Freudian thought: "Outward, forward, upward".Journal of Adult Development,12(1),19-31.
9. Lipai, T. P.(2020).The COVID-19 pandemic: Depression, anxiety, stigma and impact on mental health.Problems of Social Hygiene, Public Health and History of Medicine,28(5),922-927.
10. Logie, C. H.(2020).Lessons learned from HIV can inform our approach to COVID-19 stigma.Journal of the International AIDS Society,23(5),Article e25504.
11. Mukhtar, S.(2020).Psychological health during the coronavirus disease 2019 pandemic outbreak.International Journal of Social Psychiatry,66(5),512-516.
12. Oaten, M.,Stevenson, R. J.,Case, T. I.(2011).Disease avoidance as a functional basis for stigmatization.Philosophical Transactions of the Royal Society B: Biological Sciences,366(1583),3433-3452.
13. Rothan, H. A.,Byrareddy, S. N.(2020).The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak.Journal of Autoimmunity,109,Article 102433.
14. 中華民國重症醫學會、台灣急救加護醫學會、台灣胸腔暨重症加護醫學會（2021，5月24日），新型冠狀病毒感染（COVID-19）重症照護暫行共識。https://www.tspccm.org.tw/media/9546 [Taiwan Society of Critical Care Medicine, Taiwan Society of Emergency & Critical Care Medicine, & Taiwan Society of Pulmonary and Critical Care Medicine. (2021, May 24). Taiwan critical care consensus on COVID-19. https://www.tspccm.org.tw/media/9546]
15. 蔡宜蓁, Y.-T.,呂佩珍, P.-C.,梁蕙芳, H.-F.(2013)。愛滋病污名之概念分析。長庚護理，24(3)，272-282。
16. 衛生福利部疾病管制署（2022b，3月10日）．COVID-19國內通報總計。https://sites.google.com/cdc.gov.tw/2019ncov/taiwan [Taiwan Centers for Disease Control, ROC. (2022b, March 10). COVID-19: Total domestic notifications. https://sites.google.com/cdc.gov.tw/2019ncov/taiwan]
17. 衛生福利部疾病管制署（2022a，1月20日）．新型冠狀病毒（SARS-CoV-2）感染臨床處置暫行指引第十六版。https://www.cdc.gov.tw/File/Get/_vSWxCY7TjQn1-Gqm-wJLxg [Taiwan Centers for Disease Control, ROC. (2022a, January 20). SARS-CoV-2 infection clinical treatment interim guidelines. https://www.cdc.gov.tw/File/Get/_vSWxCY7TjQn1-GqmwJLxg]
18. 衛生福利部疾病管制署（2020，4月27日）．嚴重特殊傳染性肺炎：疾病介紹。https://www.cdc.gov.tw/Category/Page/vleOMKqwuEbIMgqaTeXG8A [Taiwan Centers for Disease Control, ROC. (2020, April 27). COVID-19: Disease introduction. https://www.cdc.gov.tw/Category/Page/vleOMKqwuEbIMgqaTeXG8A]