Gill Heart Institute, University of Kentucky, CTW 320, 900 S. Limestone Street, Lexington, KY, USA.
Gill Heart Institute, University of Kentucky, CTW 320, 900 S. Limestone Street, Lexington, KY, USA.
Heart Lung. 2019 Jan;48(1):18-21. doi: 10.1016/j.hrtlng.2018.09.013. Epub 2018 Oct 25.
Patients with advanced heart failure may experience a variety of challenges to their self-identity and quality of life due to their heart condition and treatment by implantation of a ventricular assist device (VAD). These challenges include loss of energy and stamina, loss of independence and autonomy, dependence on loved ones and caregivers for help, strained relationships with family and friends, and uncertainty about treatment outcomes and time of recovery. Narrative Medicine (NM) sessions may help patients to reflect on their situation, rediscover identity, and engage sources of meaning by telling or writing their story. This narrative process may encourage patient resilience and quality of life. The impact of illness and treatment on each patient may be understood more fully in light of each patient's unique identity and life story. Insights from NM visits may also help the treatment team as they assess patients' life situation including sources of support as well as goals and motivation for treatment. This paper provides case reports to illustrate applications of NM in the care of patients with advanced heart failure who are treated with implanted VADs. The cases include use of NM to clarify an elderly patient's motivation and consent for VAD implantation to return to favorite outdoor activities; application of perspectives from NM visits to appreciate a patient's slow but gradual improvement after VAD implantation and strong motivation for recovery; and use of a NM session to help a patient begin to overcome social withdrawal and fear after traumatic post-operative experiences.
由于心脏状况和心室辅助装置 (VAD) 的植入治疗，晚期心力衰竭患者可能会在自我认同和生活质量方面面临各种挑战。这些挑战包括精力和耐力的丧失、独立性和自主性的丧失、依赖亲人及护理人员的帮助、与家人和朋友关系紧张，以及对治疗结果和康复时间的不确定性。叙事医学 (NM) 治疗可能有助于患者反思自己的状况，通过讲述或书写自己的故事重新发现自我认同，并找到意义的来源。这个叙事过程可能会鼓励患者的韧性和生活质量。从 NM 治疗中获得的见解还可能帮助治疗团队更好地了解每位患者的独特身份和生活故事，从而更全面地了解疾病和治疗对每位患者的影响。
本文提供了一些病例报告，以说明 NM 在接受植入式 VAD 治疗的晚期心力衰竭患者护理中的应用。这些病例包括使用 NM 来阐明一位老年患者植入 VAD 以恢复喜爱的户外活动的动机和同意；应用 NM 治疗来理解患者在 VAD 植入后的缓慢但逐渐改善以及对康复的强烈动机；以及使用 NM 治疗来帮助患者克服创伤性手术后的社交退缩和恐惧。
