Mental support of family members of a patient in status asthmaticus

救急医療の現場において,今回われわれは気管支喘息重積発作の患者の身体的看護と,家族の精神的援助を行った。患者は30歳,男性,既婚,現在まで4回の気管支喘息重積発作のため入院し,その症状は薬物療法により改善された。今回の重積発作では,薬物療法が無効であったため,患者は救命救急センターに転院し,膜型人工肺による体外式肺補助循環を行った。その結果,薬物療法や人工呼吸器が有効にはたらき,発作は軽快した。救急センター転院時,医療者は患者の救命に全力をあげていたので,その家族に対する精神的援助は充分でなかった。ことに体外式肺補助循環装置使用後,家族は精神的ショックを受けていた。すなわち,妻および両親はパニック状態に陥り,兄姉は回避,怒りといった反応を示した。このように同じ家族成員間でも精神的反応に違いが見られた。これに対し看護婦は第1期(衝撃期)には家族を受容的態度でそっと静かに見守り,第2期(防御的退行期)には抑圧している感情を表出させるようにできるだけ家族に話しかけ,第3期(承認期)には,積極的に家族に対し,患者の身だしなみやリハビリの指導を行った。その後,患者の身体状況が改善されるにつれて,家族の精神的反応も改善され,患者の現状を理解できるようになり,最後は医療者に対して協力的な態度を示すようになった。このように,救急医療においては,患者の治療だけではなく患者の家族に対しても個別的な精神的援助の必要性が示された。This paper reports our experiences with a patient suffering from status asthmaticus treated with physical measures and the mental support of the members of the patient\u27s family and relatives. The patient was a 30-year-old male, married, who had been hospitalized four times due to status asthmaticus. While the patient\u27s status asthmaticus had been improved with medications in the past, no improvement was noted this time and the patient was transported to Osaka-Mishima Critical Care Medical Center (CCMC) and treated using Extra-Corporeal Lung Assist (ECLA), which led to recovery. On arrival at CCMC, the physicians and nurses concentrated on the life-saving physical treatment, and the mental support for the family was insufficient. The family was in great shock after the ECLA treatment, and the patient\u27s wife and parents were in panic. The elder brother showed avoidance behavior, and his sister displayed anger and aggressive behavior. Thus, the symptoms differed with the family member. Their mental states were as follows : at the first stage (shock stage), the nurses took a passive attitude and quietly observed the family without intervening. At the second stage (stage of defensive regression), the nurses tried to communicate with the family members as much as possible in order to have them express their depressive emotions. At the third stage (stage of acceptance), the nurses tried to actively approach the patient\u27s wife, urging her to take care of the patient to keep him tidy and guide her in the rehabilitation techniques. The mental condition of the family improved together with the recovery of the patient\u27s physical condition, which led to acceptance of his actual condition and a cooperative attitude toward the medical staff. Thus, we conclude that not only physical treatment of the patient but also mental support for the family is needed at the time of emergency treatment