應用紐曼系統模式於肺結核個案之照護經驗－個案報告

本文敘述透過社區都治計畫，照顧一位76歲罹患肺結核之個案，因藥物副作用產生生理不適導致服藥不遵從、自我隔離引起的心理衝擊的社區照護經驗。照護期間2019年8月15日至2020年3月18日，經由家訪、直接觀察及電訪等方式，運用紐曼系統模式進行整體性評估收集資料，歸納出個案有營養狀況改變：少於身體需求、服藥不遵從及社交隔離等健康問題。個案因缺乏知識與藥物副作用導致食慾不佳，筆者設計個別化菜單，提供營養攝取衛教，藉此增強免疫力，以促進疾病康復。再透過都治計畫，協助藥物管理與督促每日服藥，提升個案服藥遵從性，並積極與醫療團隊討論治療方針，改善藥物副作用。個案因疾病引發社交障礙，經筆者運用主動關懷及同理心技巧，建立信任的護病關係，使其了解隔離原因並配合接觸者調查，並協同家屬藉由視訊聯繫，降低因不安產生社交隔離之感受。照護期間適逢2020年1月嚴重特殊傳染性肺炎疫情開始流行，藉由傳遞正確防疫訊息，減少恐慌，增強防疫能力；另鼓勵2位潛伏結核感染接觸者加入遠端視訊都治，最後皆完成療程，減低後續發病之風險。期望藉此護理經驗，提供社區護理人員照護肺結核個案之參考。

關鍵字

肺結核都治計畫；紐曼系統模式；社區護理

並列摘要

This report describes a community care experience of a 76 years-old case with pulmonary tuberculosis who had drug non-compliance due to physiological discomforts caused by drug side effects and psychological impact caused by self-isolation. The duration of nursing care was from 15 August 2019 to 18 March 2020. Data were collected by home interview, direct observation, telephone interview, etc. By applying Neuman's Systems Model on overall assessment and data collection, the authors ascertained the altered nutrition status of the case: less than body requirements, medication non-compliance, and social isolation. The case had poor appetite due to poor knowledge and drug side effects, and thus, the authors designed individualized menus and provided nutrition education to help enhance his immunity and recover from the sickness. In addition, the DOTS program assisted the drug management, supervised daily drug administration, and discussed the treatment plan with the medical team to reduce drug side effects. As a result, it helped increase medication compliance of the case. Through active care and empathy, a nurse-patient trust was established, which led the case to understand the reasons for his self-isolation and cooperate in contact investigation. The authors also helped the case and family communicate through video communication to reduce a feeling of social isolation because of anxiety. The period of nursing care met the outbreak of the COVID-19 epidemic from January 2020. The transference of correct knowledge for epidemic prevention had reduced panic and enhanced the pandemic prevention capability of the case. Also, two latent tuberculosis infection (LTBI) cases were encouraged to join the DOTS program by video communication. Both had accomplished the treatment and reduced the risk of subsequent onset risk. We expect to inform future nurse professionals in caring for cases with pulmonary tuberculosis through our nursing care experience.

並列關鍵字

pulmonary tuberculosis ； medication non-compliance ； neuman's systems model ； DOTS ； community nursing

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