運用Watson關懷理論於一位突發缺氧性腦病變個案家屬之護理經驗

The Nursing Experience applying Watson's Caring Theory on Nursing Cares for a Primary Caregiver of a Sudden Hypoxic Encephalopathy Patient

王誱竩(Chieh-yi Wang)；張瀞文(Ching-wen Chang)；林君黛(Jun-Dai Lin)

缺氧性腦病變 ； 主要照顧者 ； 哀傷 ； 睡眠型態紊亂 ； 家庭因應失能 ； hypoxic encephalopathy ； the primary caregiver ； grieving disturbed sleep pattern ； disabled family coping

台灣健康照顧研究學刊

24期（2021 / 07 / 01）

86 - 105

繁體中文

本文分享一位主要照顧者面臨正值壯年的先生因急性心肌梗塞導致缺氧性腦病變的病患入加護單位，需即刻執行醫療決策，加上兩位幼童照護需求，急遽的雙重壓力需被關懷同理。因此自2020年2月3日至2020年2月26日，透過觀察、會談、行為溝通實錄與Gordon 11項健康功能型態評估等方式蒐集資料，發現主要照顧者有哀傷、睡眠型態紊亂、家庭因應失能等健康問題。筆者以Watson關懷照護為指引，給予關懷的知覺與經驗，與主要照顧者建立良好的互信關係，藉由心靈交會進入彼此的現象場，透過延長會客時間、醫療團隊主動解說病情、社工與安寧療護團隊介入協助，來降低生理、心理及社會層面（經濟）等壓力，坦然面對先生病況的發展，度過傷痛期。然而當先生疾病進展不如預期又造成另一個巨大負荷，最後決策拔除氣管內管並轉至安寧病房。筆者發現護理相關文章都以病患為取向，鮮少討論家屬的照護，因此引發筆者關注，在護理照護過程中，將重症病患與主要照護者納入照護當中，適切提供情感與實質層面的協助，輔助主要照顧者面對危機來突破困境，恢復家庭功能的運作。期許此護理經驗提供未來在面對重症病患照護之參考，期盼提升醫療照護品質。

This article presents the nursing experience of caring for a patient with hypoxic encephalopathy after acute myocardial infraction. The primary caregiver is feeling heavy pressure and needing to be empathy for her young husband who is admitted to the intensive care unit due to sudden and severe illness. The Authors use observation, depth interviews, Behavioral Process Recording, and Gordon 11 Function Health Patterns to evaluate the primary caregiver on physical dimension, psychological dimension, social dimension. Throughout the care period from February 3rd-26th, 2020. The primary caregiver identified health problems were grieving, disturbed sleep pattern, and disabled family coping. The author applied the Watson caring theory during the nursing time, providing the perception of caring and experience to build trust and relationship with the primary caregiver. With multiple soothing approaches, such as entering the phenomenal field through sharing experience, extending meeting hours, actively explaining the disease condition, and the intervention of social workers and hospice team, the primary caregiver's physical, psychological, and economic stress were reduced and she was able to cope with the development of her husband's condition and got through the time of pain. Furthermore, the author wants this caring experience to improve the quality of medical care to achieve all-person, all-family, all-process, and all-team nursing care foundation. The authors hope this experience might be a reference to share for clinical nursing staffs when care a severe illness patient should including his/her spouse.

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