運用共享決策協助慢性阻塞性肺病病人執行氣切之護理經驗

本文敘述一位慢性阻塞性肺病病人反覆急性發作、氣管內管留置合併呼吸器使用入住加護病房，住院過程出現肺炎、泌尿道感染、呼吸器困難脫離，家屬亦面臨是否執行氣切手術及後續照護地點困難決策之護理經驗。護理期間為2019年8月14日至9月2日，筆者運用羅氏適應模式進行整體性護理評估，藉由直接護理、身體評估、家屬會談、病歷查閱等方法，確立個案有氣體交換障礙、泌尿道現存性感染、照顧者角色緊張健康問題。透過直接照護，遵從組合式照護模式降低相關感染並改善氧合狀態，與個案及家屬建立信賴的護病關係，鼓勵其表達對反覆入院、治療抉擇之感受及訊息接收之需求，減少焦慮緊張情緒，運用氣切模型輔助工具提供視覺具體感受，分析慢性肺病長期照護過程氣管內管與氣切造口利弊，居家照護與慢性呼吸照護病房優劣，了解個人偏好後提供符合期待之完整訊息，最後決議接受氣切手術及返家照護，希冀藉此經驗，有助於日後護理同仁照護類似個案之參考。

關鍵字

慢性阻塞性肺病；氣切；共享決策；重症照護經驗

並列摘要

The article describes a nursing experience for a patient with chronic obstructive pulmonary disease (COPD) of recurrent acute exacerbation, with acute exacerbations, endotracheal tube indwelling and respirator application and was admitted to the intensive care unit. During hospitalization pneumonia, urinary tract infection, and difficulty in disengaging the ventilator took place. The family members also faced dilemma about whether to perform tracheostomy and choosing the location of follow-up care. Nursing period was from August 14 to September 2, 2019. Roy's Adaptation Model was used to conduct comprehensive assessment, collected and analyzed data through direct nursing, physical evaluation, conversation with patient’s families and checking medical records to confirm health problems such as gas exchange impaired, existing urinary tract infection, and caregiver role strain. Through direct nursing, follow the combined care model to reduce related infections and improve oxygenation status, establish a trusting caring relationship with the patient and his families, encourage them to express their feelings about repeated admissions, treatment choices and information reception requirements, hence reduce anxiety and tension. Utilizing the tracheostomy model auxiliary tool to provide visual experience, compare the advantage and disadvantage between homecare and chronic respiratory care ward. Finally, the patient accepted tracheostomy and homecare after we provided comprehensive information that meets their expectations. The sharing decisions making assist the patient and their families when making the appropriate decisions and the patient can return home to family care as desired. Hope this nursing experience can be beneficial to colleagues when caring for similar cases.

並列關鍵字

chronic obstructive pulmonary disease(COPD) ； Tracheotomy ； shared decision making ； experience of intensive care

參考文獻

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