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澄清醫護管理雜誌

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篇名 一位格林-巴瑞症候群個案反覆血漿置換術之重症照護經驗
卷期 17:2
並列篇名 Intensive Care Nursing Experience of a Guillain-Barré Syndrome Patient with Repeated Plasma Exchange
作者 吳珮菁鄭婉如馬瑞菊
頁次 068-077
關鍵字 格林-巴瑞症候群血漿置換術無望感Guillain-BarrePlasma exchangeHopelessness
出刊日期 202104

中文摘要

格林-巴瑞症候群患者常面臨身、心及社會等方面之壓力,本篇報告運用羅氏適應模式,探討一位初診斷格林巴瑞症候群執行血漿置換入住加護病房,遭受許多身心衝擊之適應照護經驗。本篇護理期間自2019年5月1日到5月15日,筆者運用羅氏適應模式評估系統為評估架構,藉由身體評估、觀察等方式收集主客觀資料,確立身體活動功能障礙、無望感及家庭因應能力失調等三個主要護理問題。照護期間運用團隊資源,透過復健師設計床邊復健活動計畫,並與家屬共同參與復健,採漸進式指導,建立個案對復健重要性的認知,以增進身體活動功能;主動提供治療正確資訊、提供個案宣洩負向情緒的機會、運用生命回顧法協助個案重新認定人生意義,以正向態度面對血漿置換治療,重新找回生命中的希望;藉由安排家庭會談建立家庭溝通橋樑,強化家庭內在溝通及關懷的功能,鼓勵個案家人間互相表達情感,促進家人情感交流,並聯繫社工協助辦理相關補助。格林-巴瑞症候群是一種罕見疾病,從治療到對預後的未知都是產生害怕的來源,建議未來照護此類罕見疾病個案時,護理人員除了生理上照護外,更能運用心靈層面評估與輔導,適時提供心理支持及建構支持系統,方能促使個案提升生活品質。

英文摘要

Guillain-Barre syndrome patients often experience physical, psychological, and social stress. This paper reports the experience of one female patient who was diagnosed with Guillain-Barre syndrome. She underwent plasma exchange therapy, was admitted to the intensive care unit, and experienced many physical and mental shocks. The period of care for this patient was from May 1 to May 15, 2019. Roy’s Adaptation Model of Nursing was used as an evaluation framework. Subjective data were collected through methods such as physical evaluation and observation, and three main health issues were identified: impaired mobility, hopelessness, and dysregulated family coping capacity. During the care period, we utilized inter-disciplinary team resources, designed a bedside rehabilitation plan with the aid of the rehabilitation therapist, and encouraged the family to participate in the rehabilitation process. Progressive guidance was used to improve physical mobility and allow the patient to understand the importance of rehabilitation. Furthermore, accurate treatment information was actively provided, and the patient was provided with opportunities to release negative emotions. This was supplemented with life review to assist her in redefining her meaning of life and face plasma exchange therapy with a positive attitude for a newfound hope in life. We arranged family meetings to provide bridges for communication, strengthened communication and care in the family, encouraged family members to express their emotions, promoted emotional exchanges between family members, and contacted a social worker to assist in the subsidy application. Guillain-Barre syndrome is a rare disorder that may result in fear throughout treatment and prognosis. When taking care of patients who are diagnosed with rare diseases, we recommend that medical professionals should not only provide physical care but also ensure psychological evaluation and counselling. Providing psychological support and construction of support systems at appropriate timings can improve the patient’s quality of life.

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