參與醫病共享決策之慢性腎臟病病人的醫療自主滿意度及健康管理自我效能之研究

本研究目的在運用醫病共享決策之慢性腎臟病病人的健康管理自我效能及醫療自主滿意度之探討，依其研究目的採立意取樣，對象以中部某區域教學醫院之腎臟專科門診，以參與醫病共享決策之慢性腎臟病病人135人為研究對象。研究以結構式慢性腎臟病病人健康管理自我效能及醫療自主滿意度問卷為調查工具，調查所得資料以SPSS Windows version 20.0版進行描述性統計與推論性統計。本研究結果發現:一、參與醫病共享決策之慢性腎臟病病人的健康自我管理效能的現況為總得分平均數為7.61，標準差為1.77，顯示其自我效能介於「也許可以也許不可以」與「完全可以做到」之間；二、參與醫病共享決策之慢性腎臟病病人的醫療自主滿意度的現況為總得分平均數為4.20，標準差為0.44，顯示其醫療自主滿意度介於「滿意」與「非常滿意」之間；三、參與醫病共享決策之慢性腎臟病病人其健康自我管理效能受有無工作、年齡、教育程度、婚姻狀況、慢性腎臟病病人合併有高尿酸、慢性腎臟病病人合併有高血壓、慢性腎臟病病人有無合併其他慢性病等變項影響；四、慢性腎臟病病人SDM輔助工具認知與健康管理自我效能呈正相關，並能顯著預測健康管理自我效能。本研究結果建議（一）護理教育：加強護理人員醫病共享決策及尊重病人醫療自主權之倫理與法律和衛生教育知能的養成教育與繼續教育。（二）臨床護理：1.強化慢性腎臟病病人的血壓、血糖控制，建議於衛教時增加血壓及血糖高低之處理方式，告知血壓及血糖控制重要性，提升知識及自我效能。2.加強飲食衛教，建議鼓勵病人在家用餐減少外食，請營養師教導其選擇食物、烹調方式或撰寫適合病人之菜單。3.醫療自主滿意度建議在回收問卷後，再次釐清其不懂的問題或是探討病人是否不願思考或拒絕釐清自己適合的治療方式，以不強迫，尊重病人之醫療自主權，以提升醫療自主滿意度。（三）護理行政：1.需要院方支持執行醫病共享決策的醫療照護程序。2.院方建立以個案為中心的醫病共享決策及醫療自主滿意度的增強機制，加強形塑醫護倫理典範。希望本研究結果可做為臨床護理人員照護慢性腎臟病病人之參考，共同為提昇慢性腎臟病病人全人照護的品質一起努力。

關鍵字

慢性腎臟病；醫病共享決策；健康管理自我效能

並列摘要

The purpose of this study is to explore the health management self-efficacy and medical autonomy satisfaction of patients with chronic kidney disease using shared decision-making. According to the purpose of the research, the target sample is from the kidney special clinic of a teaching hospital in the central region. A total of 135 patients with chronic kidney disease who participated in the shared decision-making. The survey study used the structural questionnaires on health management self-efficacy and medical autonomy satisfaction of patients with chronic kidney disease. The survey data were descriptive statistics and deductive statistics by SPSS Windows version 20.0. The results of this study found that: 1. The health self-management efficacy of patients with chronic kidney disease who participated in the shared decision-making was the average total score of 7.61 and the standard deviation was 1.77, indicating that their self-efficacy was between "maybe yes or maybe not" and "can do it all". 2. The medical autonomy satisfaction of patients with chronic kidney disease who participate in the shared decision-making, the average score is 4.20 and the standard deviation is 0.44, indicating that their medical autonomy satisfaction is between "satisfaction" and "very satisfied". 3. The health self-management efficacy of patients with chronic kidney disease who participate in the shared decision-making is affected by the availability of work, age, education level, marital status, chronic kidney disease patients with high uric acid, chronic Patients with kidney disease have high blood pressure, chronic kidney disease patients with or without other chronic diseases and other variables. 4. SDM cognition assistive tools in patients with chronic kidney disease are positively correlated with health management self-efficacy and can significantly predict health management self-efficacy. The results of this study suggest 1. Nursing education: Strengthening the ethics of nursing staff shared decision making and respect the patient's medical autonomy and the developing education and continuing education of the legal and health education knowledge. 2. Clinical nursing: (1) Strengthening blood pressure and blood sugar control of patients with chronic kidney disease. It is recommended to improved knowledge of the blood pressure and blood sugar level in the way of teaching, to inform the importance of blood pressure and blood sugar control. (2) Strengthening dietary education. It is recommended to encourage patients to eat at home to reduce eating out. Ask the dietitian to teach them to choose food, cooking methods or to write a menu suitable for the patient.(3) Medical autonomy satisfaction questionnaire of patients is collected, it is necessary to clarify the problem that it does not understand or to discuss whether the patient is unwilling to think or refuse to clarify the appropriate treatment method, so as not to force and respect the patient's medical autonomy to promote medical autonomy satisfaction.3. Nursing administration: 1. Require hospital support medical care procedures to implement shared decision making. 2. The hospital established a client-center rewarding mechanism for shared decision making and medical autonomy satisfaction, and strengthened the model of medical ethics. It is hoped that the results of this study can be used as a reference for clinical nursing staff to care for patients with chronic kidney disease, and team work to improve the quality of whole-person care for patients with chronic kidney disease.