奇美醫導入舒緩音樂 讓心導管病人術後不焦慮
2022-12-05 記者 蘇旋/報導
心導管術後，止血器直接壓迫在動脈傷口上止血，易造成病人肢體疼痛、麻木、發紺等不適感
一名59歲林先生，與朋友聊天時突然胸痛、冒冷汗被送至奇美醫學中心急診，醫師診斷為急性心肌梗塞，緊急執行心導管手術，術後轉加護病房觀察，在治療過程中奇美醫學中心護理部3C(心臟內科)加護病房護理團隊感受到林先生的焦慮與緊張不適，於是提供舒緩音樂轉移注意力及護理師定時訪視評估，讓林先生掌握自身狀況，藉以放鬆心情降低焦慮恐懼的情緒。
奇美醫學中心護理部督導柯雅婷
奇美醫學中心護理部督導柯雅婷指出：冬天是心臟不適好發的季節，若遇到氣溫驟降，易導致血管收縮變窄、血液流量減少造成缺血症狀，若未及時處置，恐怕會造成心肌梗塞的致命風險。
奇美醫學中心護理部督導柯雅婷說明：根據奇美醫學中心護理部3C(心臟內科)加護病房統計，2021年至2022年因心肌梗塞執行心導管手術平均1,700件。心肌梗塞發作時，需啟動緊急心導管手術來搶救生命。在搶救生命的同時，病人及家屬沒有足夠時間可接受心導管術後的護理衛教，因此常面臨兩大擔憂，一是術後止血器直接壓迫在動脈傷口上止血，易造成病人肢體疼痛、麻木、發紺等不適感，故病人常忍受術後傷口造成的不適；二為不了解加壓所需等待的時間，故時常不斷按緊急鈴求助護理師，造成病人及護理師雙方的身心疲憊。
且心導管手術後四小時內，病人需由護理人員止血密切觀察評估，內容包含：術後傷口的疼痛、麻痺感、感覺是否異常、溫度、顏色、脈搏等症狀，以守護著每位病人的安全。
奇美醫學中心護理部3C(心臟內科)加護病房護理長楊濘綺
奇美醫學中心護理部3C(心臟內科)加護病房護理長楊濘綺說明：在詢問多位急性心肌梗塞病人中，皆表示術後不知道為何需使用止血加壓器？止血加壓過程的疼痛不適如何解決？護理師是否會來評估？這些症狀是否正常？等情況，因此病人頻繁按緊急鈴，導致護理師擔心病人術後併發症而疲於奔命。
有鑑於此，團隊於2022年9月開始，以緩解病人焦慮為改善目標，依評估時間剪輯舒緩音樂，製作15至30分鐘的神曲組合(圖一)，讓病人藉由聆聽音樂放鬆心情與轉移注意力，也讓護理師精準掌握探視時間；另外，護理師訪視時間表(圖二)也同步配合音樂的時間提醒，第一個小時(每15分鐘4次)、後續三個小時(30分鐘4次)，讓病人知道只要音樂結束，護理師即會主動前來評估術後傷口，並將評估結果告知病人，增加自我照顧掌握度。
經由音樂放鬆病人心情後，追蹤病人反應，均表示在護理師清楚介紹及音樂介入轉移注意力下，可改善心中疑問、舒緩緊張情緒，確實安心許多；護理師也開心表示，在整體照護流程上，可以明顯發現病人術後的焦慮降低不少，且不再頻繁按緊急鈴，減少奔波的次數及時間，還有照護上的壓力。
奇美醫學中心護理部3C(心臟內科)加護病房護理長楊濘綺特別呼籲：民眾應注意身體保暖的重要性，急性心肌梗塞病人從不適、發作、到緊急送醫處置，往往是與死神在拔河，不可不慎！
奇美醫學中心護理部督導柯雅婷(中)率領的團隊
奇美醫學中心護理部3C(心臟內科)加護病房護理團隊將如何預防心肌梗塞及心導管術後照護衛教資訊拍攝為宣導影片，參加由中華民國護理師護士公會全國聯合會等團體共同辦理的「2022『護理的力量Power in Nursing』國際護理創意獎暨坎城未來獅培訓計畫」活動，希望讓更多民眾可以了解心導管術後的照護知識，同時以護理溫暖的力量陪伴病人度過不適焦慮的過程，藉由活動並善用新媒體量能賦能病家，形塑「您安心‧我守護」的護理專業形象。
守(手)心神曲YouTube連結：https://youtu.be/mmJl8E0iing
守(手)心神曲Facebook連結：https://www.facebook.com/watch/?v=881198139546970&extid=NS-UNK-UNK-UNK-IOS_GK0T-GK1C&ref=sharing
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