- 期刊
應用實證手法照護一位重度慢性阻塞性肺部疾病之個案
Applying Empirical-Based Methods to Care for a Patient with Severe Chronic Obstructive Pulmonary Disease
摘要
本文為照護一位重度慢性阻塞性肺部個案，因呼吸困難、咳嗽入院，且對疾病不了解、服藥不規則及未按時門診追蹤，擔心疾病惡化等負面情緒反應，故引發此次照護動機。筆者藉由身體評估、會談及健康型態評估等方法收集資料，確立個案有活動無耐力、焦慮及健康維護能力改變等健康問題，運用實證文獻查證手法，提供跨團隊照護合作，會同呼吸治療師與復健物理治療師教導噘嘴式呼吸、上肢運動以及6分鐘走路，增加運動耐力，並搭配認知行為治療、家庭社會支持、正向認知行為激勵治療及一對一的自我管理教育、同儕團體及透過多媒體影音，引導個案瞭解此疾病的症狀、可能導致疾病惡化的因子、如何預防疾病急性發作，自我保養的知識與戒菸的重要性，進而達到延緩疾病的惡化及產生自我管理能力，使得問題得以解決。出院後個案面臨戒菸成功與否，建議未來COPD且有抽菸個案，一律主動通報戒菸小組，由戒菸門診醫師與個案管理師適時介入戒菸治療與衛教，並持續追蹤，提升戒菸成功率，降低COPD危險因子，進而達到控制疾病的目標。
並列摘要
This article is about the care experience of a patient with severe chronic obstructive pulmonary disease. The case was admitted to hospital because of dyspnea and cough. Also due to lack of knowledge about the disease, irregular medication and not follow-up on time, concern about the deterioration of the disease and other negative emotional reactions, thus motivated this case. The author collects data through methods such as physical examination, interviews, health assessments, and establishes health problems such as intolerance, anxiety, and changes in health maintenance ability in this case. Applying empirical-based nursing clinical application, providing cross-team care cooperation, and meeting with respiratory therapists; Rehabilitation physiotherapists teach Pursed-lip breathing, upper limb movements and 6-minute walks to increase exercise endurance, combined with cognitive behavioral therapy, family social support, positive cognitive behavioral incentive therapy, and one-on-one self-management education, peer groups and through multimedia audio and video, guide the case to understand the symptoms of the disease. The factors that may lead to the disease, how to prevent the acute attack, the knowledge of self-maintenance and the importance of smoking cessation, so as to delay the deterioration of the disease and generate self-management ability, making the problem resolvable. After discharge, the case faces quitting smoking successfully or not. It is recommended that COPD and smoking cases be proactively notified to the smoking cessation team in the future. The smoking cessation clinician and the case manager should intervene in the smoking cessation treatment and education in a timely manner, as well as continue to track and improve the success rate of smoking cessation, and hence reduce COPD risk factors to achieve the goal of disease control.