以全人照顧理論探討一位非結核性分枝桿菌病人成功脫離呼吸器之照顧經驗

Applying Usui Holistic Care Model to Looking after a Successful Weaning from Mechanical Ventilation in the Patient of Non-Tuberculous Mycobacterium

顏玉鑫(Yu-Xin Yan)；許鏸云(Hui-Yun Hsu)

非結核性分枝桿菌 ； 呼吸衰竭 ； 脫離呼吸器 ； Non-tuberculous mycobacterium ； Respiratory failure ； Ventilatory weaning

安泰醫護雜誌

30卷1期（2024 / 06 / 01）

57 - 70

繁體中文;英文

本文描述一位非結核分枝桿菌感染個案，因急性肺炎併發呼吸衰竭初次使用呼吸器治療，協助脫離呼吸器過程之護理經驗，護理期間2020年4月13日至4月30日，筆者運用Gordon十一項功能性健康型態進行評估，經照顧過程中的直接觀察、筆談收集資料，確立健康問題有（1）呼吸機戒斷反應功能失常、（2）焦慮、（3）照顧者角色緊張。護理過程中運用全人照顧理論及現代科技醫療輔助，經由照護團隊藉由復健運動促進個案呼吸器之脫離，期間護理人員持續給予關懷、使用字版、電子產品瞭解個案之需求，使個案可表達內心之感受及疑問，達成有效性溝通，並使用音樂治療，減少個案焦慮情形，另主動與個案及照顧者討論後續出院將面臨之問題，即早的出院準備，及評估照顧者的學習程度，給予循序漸進的教學，降低照顧者的緊張情緒，同時，主要照護者也面臨到照護壓力，提早介入居家準備，最終不僅成功脫離呼吸器，也達成全人照護之目標。

This article describes a case of non-tuberculous mycobacteria infection, acute pneumonia complicated with respiratory failure and the first use of respirator for treatment, the process of assisting the process of weaning from the respirator, and the nursing experience of assisting the primary caregiver to prepare for hospital discharge. Data were collected between April 13, 2020 and April 30, 2020, using Gordon 11-Items Functional Health Patterns, evaluate and collect data, Health problems identified included, dysfunctional ventilator withdrawal response, anxiety, and caregiver role stress. During the nursing process, used rehabilitation exercises to promote the release of the patient's respirator. Duration of hospital stay, the nursing staff continued to provide care, and used word card and electronic products to understand the needs of the patient. , so that the patient can express his feelings and doubts, achieve effective communication, and use music therapy to reduce the anxiety of the patient, and actively discuss with the patient and the caregiver the problems that will be faced in the follow-up discharge, then early discharge preparation, and assessment the learning level of the patient, step-by-step teaching is given to reduce the tension of the caregiver. At the same time, for the main caregivers, early intervention in home preparations not only succeeded in getting out of the respirator, but also achieved the goal of holistic care.