加護病房資深護理人員對多重器官衰竭病人及其家屬的關懷經驗

Senior Nurses' Experience Caring for Patients with Multiple Organ Failure in Intensive Care Units and Their Families

10.6142/VGHN.202206_39(2).0007

郭憶文(Yi-Wen Kuo)；周幸生(Shin-Shang Chou)；穆佩芬(Pei-Fan Mu)

加護病房 ； 資深護理師 ； 多重器官衰竭 ； 關懷經驗 ； 質性調查 ； intensive care unit ； senior nurse ； multiple organ failure ； experience of caring ； qualitative inquiry research

榮總護理

39卷2期（2022 / 06 / 01）

187 - 197

繁體中文

背景：多重器官衰竭是加護病房中常見的死因，會導致病人組織損傷，器官功能障礙，經歷死亡威脅，關懷照護對加護病房資深護理師來說是充滿意義的，也是巨大的挑戰。目的：採質性調查研究法，了解加護病房資深護理師照護多重器官衰竭病人及家屬關懷經驗。方法：研究對象為加護病房資深護理師，採半結構式訪談指引進行訪談，以內容分析法進行資料分析，當分析未發現新主題，即達到數據飽和，並以Lincoln及Guba（1985）提出的四個準則進行嚴謹度控制。結果：本質性研究自2015年7月3日至10月31日，共收案10位，皆是女性，平均年齡43歲，加護病房平均年資15年，研究發現護理人員關懷經驗共六個主題：一、縝密評估，即時掌控病況；二、凝聚團隊，協調共享決策；三、貼近病人，同感病人經驗；四、洞察需求，療癒家屬苦痛；五、生命末期，勇於圓滿善別；六、自我轉化，淬鍊照護能量。結論：結果發現，資深護理師可以預測預後，整合團隊，監控治療時機，挽救病人生命，並了解病人的心理，協助保持尊嚴，同時照顧家屬，實現其願望並彌補遺憾，而當醫療已然無效時，提供臨終關懷，確保病人及家屬擁有平靜莊嚴的生命終點。本研究提供照護多重器官衰竭病人及家屬的關懷本質，未來可應用於在職教育訓練設計、建立特殊照護指引和跨團隊的照護。

Background: Multiple organ failure (MOF) leads to tissue damage and organ dysfunction and is the most common cause of death in the intensive care unit (ICU). Patients with MOF and their families must cope with the prospect of serious illness and death. Caring for patients with MOF is a major challenge for nurses in the ICU. Aims: This study used qualitative research to understand the experience of senior nurses in the ICU caring for patients with MOF and their families. Methods: Ten senior nurses in the ICU participated in this study, each of whom partook in a semistructured interview. Narrative data were analyzed through content analysis. No new themes were observed during data analysis, and data saturation was achieved. The interviews were conducted by strictly controlling for the four criteria proposed by Lincoln and Guba (1985). Results: From July 3 to October 31, 2015, ten senior nurses, all women, with an average age of 43 years and average experience in the ICU of 15 years, were interviewed. The results revealed six themes: (1) the careful assessment and control of disease in a timely manner, (2) teamwork and shared decision-making, (3) respect for patients' inner worlds, (4) perception of families' needs, (5) end of life and communication of final goodbyes, and (6) self-transcendence to refine caring strategies. Conclusions: Senior nurses should provide prognoses, utilize teams, and manage treatment to care for patients with MOF. Senior nurses should also explore patients' thoughts to help them maintain their dignity throughout treatment. In addition, they should care for patients' families by helping them cope with potential loss. Senior nurses can also provide hospice care to patients for whom all medical options have been exhausted to ensure that the end-of-life experience is peaceful for the patients and their families. Elucidating senior nurses' experience caring for patients with MOF and their families in the ICU provides a reference for developing education packages, guidelines, and supportive multidisciplinary teams.

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