運用醫療共享決策協助一位焦慮之透析治療病人的加護經驗

The Nursing Experience of Using Shared Decision Making to Assist an Anxious Dialysis Patient

湯詠榆(Yung-Yu Tang) ； 黃心慈(Shin-Tsyr Hwang) ； 林秀靜(Hsiu-Ching Lin)

《臺大護理雜誌》 16卷1期 (2020/01) Pp. 89-100

https://doi.org/10.6740/NTUHJN.202001_16(1).0009

摘要

本文描述一位初次診斷法布瑞氏症引發末期腎病須長期接受血液透析病人，因血液透析過程中歷經心肺復甦術與植入心律整流去顫器，面對疾病持續變化與需接受各種治療而感到不確定，害怕死亡，產生焦慮與醫療決策疑慮，因個案身心需求，故引發照護動機。護理期間自2017年3月6日至3月13日，以Gordon 11項功能性健康型態評估工具，運用直接照護、身體評估、觀察及筆談等方法歸納個案有體液容積過量、氣體交換障礙及焦慮等主要健康問題。照護期間給予個別性護理，透過個案參與醫療決策方式獲取正確醫療資訊，引導正向面對疾病，提升對疾病了解程度。藉由關懷照護及心理支持建立良好的護病溝通，減少對環境的陌生感，減輕壓力與焦慮，滿足心靈需求，讓個案能順利轉出加護病房。藉由此護理經驗，建議在照護對醫療處置感到焦慮與徬徨無助之重症病人，可適時運用醫療共享決策讓病人共同參與醫療過程，滿足病人身心需求，藉此提升照護品質。

關鍵字

醫療共享決策 ； 焦慮 ； 透析

並列摘要

This article presents a patient with newly diagnosed Fabry disease-induced end-stage renal disease, who requires long-term hemodialysis. He underwent cardiopulmonary resuscitation during a hemodialysis section and was implanted with a cardioverter defibrillator. In this context, he showed uncertainty regarding the medical treatments, fear of death, and anxiety regarding decision-making. The author was thus motivated to care for his physical and mental needs. During the nursing period from March 6th to March 13th, 2017, Gordon's 11 functional health patterns were used to summarize his problems - which included fluid overload, blood gas abnormality, and anxiety - with the use of direct caring, physical assessments, observations, and written interviews. Individual care was given during the period, and shared decision-making was used to provide him with accurate medical information, a better understanding of the disease, and generate a positive attitude towards illness. Through caring and mental support, a good nurse-patient relationship was established with good communication. In this way, his feelings of alienation were resolved, stress and anxiety were reduced, mental barriers were overcome, psychological needs were met, and he was smoothly transferred out of the ward. With this nursing experience, it is recommended to use co-decision-making for patients with severe anxiety and helplessness in the context of medical treatments. This approach allows patients to participate in the medical process such that their physical and mental needs can be met, thereby improving the quality of care.

並列關鍵字

shared decision making ； anxiety ； dialysis