運用醫病共享決策照顧一位慢性阻塞性肺病病人之急診護理經驗

Experience in Nursing: Using Shared Decision-Making on a Patient with COPD at Emergency Room

張庭(Ting Chang) ； 邱秀娟(Hsiu-Chuan Chiu)

《志為護理-慈濟護理雜誌》 22卷2期 (2023/04) Pp. 106-115

摘要

本文描述在急診運用醫病共享決策協助罹患慢性阻塞性肺病病人末期醫療抉擇之經驗。護理期間2019年11月27日0119至1610，依Gordon十一項功能性健康型態評估進行整體性評估，以會談、身體評估、實際照護及病歷查閱等方式收集資料，確立主要健康問題為（一）氣體交換功能障礙；（二）活動無耐力；（三）抉擇衝突。透過復健活動使個案出院前能在無使用氧氣的情況下血氧達到95%，引導個案表達對末期醫療之擔憂，並運用醫病共享決策之醫療輔助工具協助個案訂定醫療目標，當日個案決定簽屬安寧緩和同意書，後續於門診複診及電訪追蹤。期望藉此經驗提供照護此類個案之參考。

關鍵字

慢性阻塞性肺病 ； 抉擇衝突 ； 醫病共享決策

並列摘要

This article describes the emergency care experience of a patient with chronic obstructive pulmonary disease, using shared decision-making between doctors and patients to help patients make final medical decisions. During the nursing care period, from 01:19 am to 04:10 pm on November 27, 2019, an overall assessment was carried out according to the Gordon 11 Functional Health Pattern. Three major health problems were identified, 1. gas interchange disturbance, 2. Activity Intolerance, 3. Decisional Conflict. The patient was guided to express their concerns about terminal medical care and provided with answers to their questions, using the medical aid tool of shared decision-making between doctors and patients to assist cases in setting medical goals. Additionally, through rehabilitation activities the patient could reach Oxygen saturation 95% without oxygen use before discharge. At 04:10 pm of the same day, the patient decided to sign the consent form of hospice palliative and was discharged from the hospital. On November 28, outpatient follow-up visits and follow-up telephone interviews were conducted. It is hoped that this nursing experience will provide a reference for caring for such cases.

並列關鍵字

chronic obstructive pulmonary disease ； decisional conflict ； shared decision-making

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