提升呼吸器依賴病人家屬對整合照護之認知

Increasing the Family Awareness of the Integrated Delivery System (IDS) for Patients with Ventilator-Dependence

鄭瑞貞(Jui-Chen Cheng) ； 高秀娥(Hsiu-O Kao) ； 陳瑞儀(Jui-Yi Chen) ； 黃筱芳(Hsiao-Fang Huang) ； 鄭之勛(Jih-Shuin Jerng) ； 古世基(Shih-Chi Ku) ； 林佳穎(Chia-Ying Lin) ； 張寶綾(Bao-Lin Chang)

《台灣醫學》 23卷4期 (2019/07) Pp. 434-445

https://doi.org/10.6320/FJM.201907_23(4).0003

摘要

本專案旨在提升呼吸器依賴病人家屬對垂直整合照護認知率。專案動機係因家屬針對亞急性呼吸照護病房病人轉出後之延續照護規劃，常會面臨決策困難與煎熬。經探討發現家屬對呼吸器依賴重直整合照護的認知率僅41.4%，因而影響其對病人後續延續照護的選擇。而家屬認知率低的原因包含單位衛教工具不足、臨床人員對於呼吸器脫離進度多變與方式繁瑣、個別化目標不清楚、家屬探病次數少與下轉動向選擇多。因此，運用改善措施包含：召開專家會議討論標準化呼吸器脫離計畫、製作個別化呼吸器脫離訓練階段與復健進度指導海報、亞急性呼吸照護病房簡介與延續性照護影片、呼吸器依賴病人家屬垂直整合照護流程海報與實施標準化呼吸器脫離計畫。經改善措施後家屬認知率顯著提升，自41.4%上升至91.9%，顯示改善措施有效性。建議可推廣至他院，提升此類病人照護之品質。

關鍵字

呼吸器依賴病人 ； 認知 ； 共享決策

並列摘要

The purpose of this program was to increase the knowledge of the integrated delivery system (IDS)-based care for ventilator-dependence patients. As the families often face difficulty and psychological burden in the decision making for the disposition of the patients, our investigation showed that the family members had poor knowledge of IDS-based care with only 41.4% showing accurate understanding. This lack of understanding might affect the choice for continued care. Possible reasons include lack of proper educational tools, the high variety and complexity of weaning process, the unclear goal for individual patients, infrequent family visits to the patient, and multiple choices for patient disposition. The improvement team members gathered and discussed, then developed and implemented a series of strategies, including standardization of weaning process, a demonstrating panel with a personalized timetable of weaning and rehabilitation, a brief video to introduce the IDS and continued care, poster display regarding the IDS-based care and protocoled weaning. After the implementation of the above strategies, the understanding improved to 91.9%. We, therefore, suggest that our implementation of these strategies provides valuable insights and worth spreading and generalization.

並列關鍵字

mechanical ventilation-dependent patients ； cognition ； shared decision-making

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