题名

一位心衰竭末期病人於加護病房中運用安寧照護理念善終之護理經驗

并列篇名

The Nursing Experience of A Terminal Stage Heart Failure Patients Receive Hospice Share Care Concept in the Intensive Care Unit

DOI

10.6537/TJHPC.2017.22(1).7

作者

李平智(Ping-Chih Li);張嫚娜(Man-Na Chang);陳佩卿(Pei-Ching Chen)

关键词

安寧療護 ; 生命末期照護 ; 加護病房 ; Hospice Share care ; end of life care ; intensive care unit

期刊名称

安寧療護雜誌

卷期/出版年月

22卷1期(2017 / 03 / 01)

页次

85 - 96

内容语文

繁體中文

中文摘要

本文是以安寧緩和共照模式,協助一位入住加護病房心衰竭末期病人及家屬面對生命末期的照護經驗。筆者於2013年5月20日至6月7日,依生、心理、社會與靈性層面進行評估,確立下列主要照護問題:(1)生理層面:體液容積過量/心、腎功能受損導致、疼痛/心衰竭及疾病進展導致;(2)心靈困擾/未準備好面對死亡。護理過程中,透過家庭會議方式,與病人、家屬、醫療共照成員共同擬定照護計畫。協助舒適臥位、藥物、氧療及限制水份,以減輕呼吸費力;使用冰枕、精油與穴位按摩、唸佛號、藥物等方法緩解疼痛;運用關懷、肢體接觸、陪伴,傾聽病人及家屬內心感受,適時運用安寧理念介入,使病人明白生命選擇的自主及尊嚴;彈性開放會客,讓家人陪伴,減輕焦慮及哀傷。隨時觀察反應,適時修正照護計畫。使病人及家屬能面對逐漸死亡的衝擊及哀傷反應,感受身、心、靈的全方位照護的生命末期護理。

英文摘要

This article is focus on nursing experience of hospice share care Concept in ICU for a terminal stage heart failure patients and their families face the end of life. The author form May 20 to June 7, 2013 according to the health, psychological, social and spiritual dimensions evaluated to establish the following primary caregiver issues: (1) physical issues including: body fluid overdose volume related to heart, kidney dysfunction, the pain of heart failure progression ; (2) social psychological issues: the crisis situation and is not ready to face death. Nursing process, through family conferencing with patients, their families and members of the medical to co-develop plan of care. Use of Comfortable supine, medicines, oxygen and water restrictions, in order to reduce respiratory distress; use ice pillow, massage with essential oils, recite numbers, drugs and other ways to ease the pain; use physical contact, accompany, listen patients and their families inner feelings, to study and positive coping strategies, so that patients understand the true meaning of life; flexible open time, let the family accompany, reduce anxiety and grief. Always observe the reaction, timely amendment care plan. So that patients and their families to face of gradually die the shock and grief reactions, feeling body, mind and spirit of all-round care of end of life care.

主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
参考文献
  1. 行政院衛生署中央健康保險局電子報。生命盡頭的尊重。2014 年 9 月號,取自http://www.nhi.gov.tw/epaper/ItemDetail.aspx?DataID=3843&IsWebData=0&ItemTypeID=5&PapersID=340&PicID=
  2. Fridh, I.,Forsbrg, A.,Bergbom, I.(2007).Family presence and environmental factors at the time of a patient's death in an ICU.Acta Anaesthesiol Scand,51(4),395-401.
  3. Hopp, FP.,Thornton, N.,Martin, L(2010).The lived experience of heart failure at the end of life: a systematic literature review.Health Soc Work,35(2),109-117.
  4. Koenig, HG(2007).Physician attitudes toward treatment of depression in older medical inpatients.Aging Ment Health,11(2),197-204.
  5. Larson, LW,Gerbert, DA,Herman, LM(2006).ACC/AHA 2005 guideline update: chronic heart failure in the adult.JAAPA,19(4),53-56.
  6. Lemond, L,Allen, LA(2011).Palliative care and hospice in advanced heart failure.Prog Cardiovasc Dis,54(2),168-178.
  7. Murray, S.A.,Kendall, M.,Grant, E.,Boyd, K.,Barclay, S.,Sheikh, A.(2007).Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure.J PAIN SYMPTOM MANA,34(4),393-402.
  8. Olshansky, B,Wood, F,Hellkamp, AS(2007).Where patients with mild to moderate heart failure die: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).Am Heart J,153(6),1089-1094.
  9. Skinner, J,McKinney, A(2011).Acute cardiogenic pulmonary oedema: reflecting on the management of an intensive care unit patient.Nurs Crit Care,16(4),193-200.
  10. 白筱雯,宋怡憓,李彩緣(2009)。照護一位心臟衰竭病患之護理經驗。若瑟醫護雜誌,6(1),107-118。
  11. 吳春桂,林宏茂,林芳如,林亞陵,蔡紋苓,廖婉玲,黃勝堅(2011)。重症生命末期照護之新趨勢。台灣醫學,15(1),37-47。
  12. 李怡樺,林琪馨(2013)。運用芳香療法於口腔癌術候個案之護理經驗。澄清醫護管理雜誌,9(3),49-57。
  13. 林純如,胡文郁,王浴,呂佩佩(2011)。癌末病人使用皮下輸注現況之探討。安寧護理雜誌,16(1),14-26。
  14. 馬瑞菊,蔡惠貞(2013)。提供重症善終服務:改善加護病房生命末期照護。馬偕護理雜誌,7(1),7-13。
  15. 許煌汶(2009)。重症加護病房理生命末期照護的溝通。若瑟醫護雜誌,3(1),16-23。
  16. 郭懿玲,林采蓉,黃敏瑢(2012)。照護一位肺癌病人面臨生命末期之加護經驗。長庚護理,23(3),381-388。
  17. 衛生福利部中央健康保險。新聞發布,今(98)年 9 月 1 日起,新增八類非癌症重症末期病患也能接受安寧療護服務,並正式納入健保給付。2009 年11 月 11 日,取自http://www.nhi.gov.tw/information/NewsDetail.aspx?menu=9&menu_id=544&No=808
  18. 賴文源,顏兆熊(2011)。老人之心衰竭。當代醫學,38(3),175-183。
被引用次数
  1. 鍾儷薇(2022)。一位直腸癌末期病人安寧善終之加護照護經驗。志為護理-慈濟護理雜誌,21(1),110-118。