運用共同決策照護一位心臟衰竭病人之護理經驗

Nursing Experience of Using Shared Decision Making to Assist a Heart Failure Patient

鍾郡家(Chun-Chia Chung) ； 楊舜璇(Shun-Hsuan Yang)

《臺大護理雜誌》 15卷2期 (2019/07) Pp. 96-107

https://doi.org/10.6740/NTUHJN.201907_15(2).0010

摘要

本文描述如何運用共同決策（share decision making, SDM）協助一位自主意見強，難以接受醫療團隊的治療與照護之心臟衰竭個案，從無法適應疾病，至逐漸接受身體功能衰退並且參與後續照護計畫的過程。於2016年6月13日至8月8日，經由評估、觀察、會談與醫療團隊討論等方式進行相關資料收集，並運用Gordon 11項功能性健康型態評估分析，確立個案有焦慮、不遵從及心輸出量減少等健康問題。針對上述健康問題，運用共同決策的概念，藉由家庭會議，讓醫療團隊、個案及家屬充分地溝通與討論後，協助個案理解並接受疾病進展，減輕焦慮，且在落實自主原則下使個案能遵從配合藥物和非藥物治療，維持理想體重與保持每日水份進出量平衡，進而降低心臟負荷，提升生活品質。建議於臨床照護自主性強之病人宜在病人入院初始就運用共同決策，在尊重病人價值觀下，鼓勵病人及家屬共同參與討論確定住院目標及治療方針，以提升病人的遵從性，使照護更有效率及完善。期望此運用共同決策護理經驗，提供臨床護理人員照護心臟衰竭病人之參考。

關鍵字

共同決策 ； 心臟衰竭

並列摘要

This case report described how the medical team uses share decision making (SDM) to care for a patient with heart failure. A patient with high autonomy and difficulty in receiving treatment and care from the medical team can ultimately accept the decline of physical function and participate in the process of the care plan. From June 13 to August 8, 2016, we utilized Gordon's 11 Functional Health Patterns to collect subjective and objective data through assessments, observations, conversation, and discussion with medical teams. Finally, we identified three main healthcare problems, including anxiety, noncompliance, and decreased cardiac output. Focusing on these problems, we used SDM to invite the medical team, the patient, and the family to communicate with each other. The meeting reduced the patient's anxiety and assisted with patient understanding and acceptance of disease progression. The patient became more compliant with the doctor's medications and treatment, and started to maintain ideal body weight and balanced daily fluid intake and output to reduce the heart load, which improves the patient's quality of life. we recommends that SDM be used by nurses facing patients with high autonomy at the initial admission. By respecting the values of patients, encouraging patients and family members to participate in the discussion, and determining treatment goals, SDM can improve the patient's compliance and achieve optimal outcomes. We hope this case report will provide some suggestions to clinical nurses caring for such patients.

並列關鍵字

shared decision making ； heart failure