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| 題 名 | 運用不確定感理論於一位疑似肌萎縮性脊髓側索硬化症併急性呼吸衰竭之照護經驗=Applying Uncertainty in Illness Theory to the Care Experience of a Patient with Suspected Amyotrophic Lateral Sclerosis Complicated by Acute Respiratory Failure |
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| 作 者 | 施瑀柔; 章雅茜; 蔡政潔; | 書刊名 | 華醫學報 |
| 卷 期 | 63 2025.12[民114.12] |
| 頁 次 | 頁21_1-36 |
| 分類號 | 419.821 |
| 關鍵詞 | 疾病不確定感理論; 肌萎縮性脊髓側索硬化症; 照護經驗; Amyotrophic lateral sclerosis; Psychological adaptation; Respiratory failure; Uncertainty in illness theory; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 本文為照護一位雙下肢肌肉無力、呼吸困難個案,過程中意識改變、高碳酸血症 放置氣管內管,入加護病房治療。照護期間 2024 年 5 月 31 日至 2024 年 6 月 24 日, 依據 Mishel 不確定感理論進行整體性評估,透過直接照護、身體評估、會談、觀察及 病歷查閱等方式確立護理問題為低效性呼吸型態/與疑似 ALS 導致呼吸肌疲憊有關、 不確定感/與疑似 ALS 疾病之症狀、治療成效及未來因應有關。護理過程提供肺部運 動及氣切共享決策資訊進行呼吸器脫離訓練。面對病況進展及多項檢查,加深對自身 疾病、未來因應的不確定感,顯露出擔憂、恐懼等情緒。透過提供疾病相關資訊、心 理支持、引導表達感受等,降低不確定感。臨床上著重生理照護,建議重症單位可安 排臨床心理師與團隊共同照護。 |
| 英文摘要 | The care of a patient admitted with bilateral lower-limb weakness and respiratory distress, later complicated by altered consciousness and hypercapnia requiring intubation and ICU admission, was documented from May 31 to June 24, 2024. Mishel’s Uncertainty in Illness Theory was applied to guide holistic nursing assessment. Through physical assessment, interviews, observations, and chart review, an ineffective breathing pattern related to suspected ALS-induced respiratory muscle fatigue and heightened illness uncertainty were identified. Pulmonary exercises were administered, and shared decisionmaking regarding tracheostomy was facilitated for ventilator weaning. As the patient’s condition progressed, uncertainty regarding symptom trajectory and future functioning increased, accompanied by anxiety and fear. To address these concerns, disease-related information, emotional support, and guidance in expressing thoughts were provided. Given the psychological impact of uncertainty, the inclusion of clinical psychologists in ICU teams is recommended to strengthen holistic patient support. |
本系統中英文摘要資訊取自各篇刊載內容。