多團隊呼吸困難照護群組在肺癌住院病人呼吸困難之臨床應用

A Clinical Application of Dyspnea Care Bundle for Hospitalized Lung Cancer Patients with Dyspnea

張碧華(Pi-Hua Chang) ； 許帆媗(Fan-Hsuan Hsu) ； 江秀慧(Hsiu-Hui Chiang) ； 劉怡伶(Yi-Lin Liou) ； 陳美玉(Mei-You Chen) ； 吳佳蕓(Chia-Yun Wu) ； 張基晟(Gee-Chen Chang)

《腫瘤護理雜誌》 16卷增訂刊 (2016/10) Pp. 57-74

https://doi.org/10.3966/168395442016101603005

摘要

呼吸困難是主觀的感覺，常見的測量或檢驗方式無法立即顯示病情進展速度，不易藉由臨時或緊急醫療處置而迅速緩解，病人則處於氣管內管置入與否的困境，並危及生命安全。實證問題為呼吸困難照護群組是否能改善肺癌住院病人呼吸困難程度？屬於治療型問題，群組措施包括：氧氣治療、噘嘴呼吸訓練、肺部復健、電風扇、嗎啡、雙向正壓呼吸器。經實證文獻評讀步驟，研究設計偏差的評分結果在12.5~87.5%，結合呼吸困難費力量表，設計「照護群組」雙面卡，醫護人員及病人對呼吸困難照護群組執行後的滿意度各為85.6%及87.5%。本案利用實證護理教育，結合呼吸困難評估工具及實證措施，證實肺癌住院病人呼吸困難緩解需要多專業團隊組合的照護群組及監測，以符合醫療資源有效應用及出院準備的長期目標。

關鍵字

肺癌 ； 呼吸困難 ； 多團隊 ； 照護群組

並列摘要

Dyspnea is a subjective perception which cannot be used to immediately reflect patients' conditions on medical equipment or with tests. If the symptom cannot be easily relieved by medical treatments, patients face the dilemma of intubation risks and life-threatening complications. A clinical question exists whether the dyspnea care bundle mitigates dyspnea in hospitalized lung cancer inpatients. The dyspnea care bundle includes six interventions: oxygen therapy, pursed-lip-breathing, pulmonary rehabilitation, fan, Morphine, and biphasic positive airway pressure (BiPAP). We researched some original related literatures and designed a double-sided card combining the dyspnea exertion scale (DES) and six interventions. After the implementation of the dyspnea care bundle, the satisfaction rates of multidisciplinary team members and patients are 85.6% and 87.5%, respectively. Through the evidence-based education and practices, this study revealed that the dyspnea care bundle with its multidisciplinary collaboration could benefit the hospitalized lung cancer patients while reaching the goal of effective medical resources management and adequate discharge preparations.

並列關鍵字

Lung cancer ； dyspnea ； multidiscipline ； care bundle

參考文獻

侯升雍、李茹萍（2009）．護理人員照護癌末呼吸困難病患的知識、態度與行為趨向之研究．護理雜誌，56（3），46-56。[Hou, S. Y. & Lee, R. P. (2009). Nurses’ Knowledge, Attitudes and Behavior Intentions in the Care of Terminal Stage Cancer Patients with Dyspnea. The Journal of Nursing, 56(3), 46-56. doi: 10.6224/JN.56.3.46]

陳昱芬、黃惠美、陳孟君、徐金菊、張碧華、徐倩儀及張美玉（2015）．建立癌症病人呼吸困難臨床照護指引．榮總護理，32（3），256-276。[Chen, Y. F., Huang, H. M., Chen, M. J., Hsu, C. C., ... Chang, M. Y. (2015). Developing Clinical Practice Guidelines for Patients with Cancer-Related Dyspnea. VGH Nursing, 32(3), 256-276.] doi: 10.6142/VGHN.32.3.256

謝慧觀、林蕙鈴（2014）．緩和照護中伴隨呼吸困難病人的處置．呼吸治療雜誌，12（2），23-33。[Shie, H. G., & Lin, H. L. (2014). Management of Dyspnea in Patients under Palliative Care. Journal of Respiratory Therapy, 13 (2), 23-33. doi: 10.6269/JRT.2014.13.2.03]

Ahmedzai, S. H., & Shrivastav, S. P. (2004). Breathlessness. Medicine, 32(4), 14-16. doi: http://dx.doi.org/10.1383/medc.32.4.14.32917

Bausewein, C., Farquhar, M., Booth, S., Gysels, M., & Higginson, I. J. (2007). Measurement of breathlessness in advanced disease: A systematic review. The Journal of Respiratory Medicine, 101(3), 399-410. doi:10.1016/j.rmed.2006.07.003