Wang Yo-Ping, Chuang Pao-Yu, Gone Shu-Ing, Tseng Chi-Ying
BSN, RN, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
MSN, RN, Supervisor, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2020 Dec;67(6):104-110. doi: 10.6224/JN.202012_67(6).14.
The author's experience caring for a patient with COVID-19 whose condition deteriorated rapidly into a critical illness in the negative pressure room of the intensive care unit is described in this article. The onset of severe acute respiratory distress syndrome led this patient to receive endotracheal intubation with mechanical ventilation and subsequent extracorporeal membrane oxygenation for life support. He was isolated in the negative air pressure room in the intensive care unit for infection control for this emerging respiratory infectious disease. This patient was also confronted with emotional pressures arising from the general uncertainty regarding the progress of this novel disease and from being isolated from the outside world. The care period was from April 5th to May 12th, 2020. The data was collected through direct care, written conversations, physical communication, observation, medical record reviews, diagnosis reports, and nursing assessments of physical, psychological, social, and spiritual distress. The health problems of this patient were identified as gas exchange disorder, infection, anxiety, and other problems. Our chest physiotherapy team comprised nurses, physicians, and respiratory therapists. After administering individualized treatments, including monitoring vital signs and installing an external life support system, the lung consolidation and lung collapse problems of the patient improved, allowing the ventilator to be removed. To address the patient's psychological problems, we used a humanoid diagram and whiteboard drawing as communication tools to explain to the patient the reasons for and functions of the different tubes on his body to reduce his anxiety and maintain the safe use of these tubes. Moreover, bedside care was replaced by mobile phone video and phone calls, allowing the patient to communicate with family members, which reduced his isolation-related anxiety and enhanced his compliance with treatment and care protocols. This experience supports the benefit of installing two-way video devices and viewing monitors in negative pressure rooms in the ICU to facilitate effective communications between patients, patient family members, and the medical team to reduce patient-perceived anxiety and social isolation. This case report provides a reference demonstrating a patient-centered caring model for treating COVID-19 patients in the ICU.
本文描述了作者在重症监护病房的负压病房护理一名新冠肺炎患者的经历，该患者病情迅速恶化为危重症。严重急性呼吸窘迫综合征的发作导致该患者接受气管插管并进行机械通气，随后接受体外膜肺氧合以维持生命。由于这种新发呼吸道传染病的感染控制需要，他被隔离在重症监护病房的负压病房。该患者还面临着因这种新型疾病进展的普遍不确定性以及与外界隔离而产生的情绪压力。护理期为2020年4月5日至5月12日。数据通过直接护理、书面交谈、身体交流、观察、病历审查、诊断报告以及对身体、心理、社会和精神痛苦的护理评估收集。该患者的健康问题被确定为气体交换障碍、感染、焦虑等问题。我们的胸部物理治疗团队由护士、医生和呼吸治疗师组成。在给予包括监测生命体征和安装体外生命支持系统在内的个体化治疗后，患者的肺实变和肺萎陷问题得到改善，从而能够撤掉呼吸机。为了解决患者的心理问题，我们使用人体示意图和白板绘图作为沟通工具，向患者解释其身上不同管子的用途和功能，以减轻他的焦虑并确保这些管子的安全使用。此外，床边护理被手机视频和电话取代，使患者能够与家人沟通，这减轻了他与隔离相关的焦虑，并提高了他对治疗和护理方案的依从性。这一经验支持了在重症监护病房的负压病房安装双向视频设备和可视监视器的益处，以便促进患者、患者家属和医疗团队之间的有效沟通，从而减少患者感知到的焦虑和社会隔离。本病例报告提供了一个参考，展示了在重症监护病房治疗新冠肺炎患者的以患者为中心的护理模式。
