運用醫病共享決策工具協助視神經脊髓炎病人氣切抉擇衝突之護理經驗

本文描述照護一位視神經脊髓炎病人合併呼吸衰竭，因呼吸器脫離困難面臨氣切抉擇的護理過程。正值壯年及插置氣管內管的臥床病人，面臨氣切存有的迷思及承受是否氣切的抉擇痛苦。護理期間2018年12月15日至2019年1月14日，運用生理、心理、社會、靈性四大層面為架構進行評估，確立主要健康問題有呼吸道清除功能失效、組織完整性受損及抉擇衝突；照護期間教導肺部復健運動增加呼吸肌肉力量；衛教及回覆示教外籍傭人有關傷口照護、翻身擺位及關節運動等照護技能；與病人建立良好護病關係、傾聽病人對氣切的感受，開立家庭諮詢會議使用醫病共享決策輔助工具，讓病人選擇及同意氣切手術。建議臨床上廣泛使用醫病共享決策來輔助病人決策，也期望將此照護經驗提供臨床參考。

關鍵字

醫病共享決策；家庭諮詢會議；視神經脊髓炎；抉擇衝突

並列摘要

This article describes the nursing approach while providing care to a patient with neuromyelitis optica and respiratory failure who was facing the dilemma of a tracheotomy due to difficult ventilatory weaning. The patient became bedridden while in the prime of her life and put on endotracheal intubation. She was struggling with the decision and confusion about the tracheotomy, and such hesitation on making the decision became regrettable. During the nursing period from December 15th, 2018 to January 14th, 2019 and according to the patient's physical, psychological, social, and spiritual condition through interviews and observation, it was established that this patient's main health problems were: ineffective airway clearance, impaired tissue integrity, and decisional conflict. During the nursing period, a health educator instructed the patient on how to perform an individualized pulmonary rehabilitation program in order to increase muscle strength. The caregiver was also trained on how to administer wound care, change body positions and perform joint exercises. In an attempt to maintain a good relationship between the patient and care provider, we empathized with and listened to the patient's feelings about the tracheostomy. Holding a family meeting session to share experiences and use the tool of Shared Decision-Making for patients to clarify any confusion allowed the patient to choose and agree to the tracheostomy. It is recommended that Shared Decision-Making be widely used clinically to assist patients in decision-making, and it is hoped that this nursing experience can be used as a reference for clinical practice.

並列關鍵字

Shared Decision Making ； family meeting ； neuromyelitis optica ； decisional conflict

參考文獻

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