運用共享決策於一位格林－巴瑞症候群個案之照護經驗

Using Shared Decision-Making on a Patient with Guillain-Barré syndrome: A Care Experience

10.6386/CGN.202209_33(3).0012

周育瑄(Yu-Hsuan Chou)；金瑞美(Jui-Mei Chin)；陳芷萱(Chih-Hsuan Chen)；陳虹如(Hung-Ju Chen)

格林－巴瑞症候群 ； 共享決策 ； 身體活動功能障礙 ； Guillain-Barré syndrome ； Shared Decision-Making ； decreased physical activity

長庚護理

33卷3期（2022 / 09 / 01）

132 - 141

繁體中文

本文探討一位罹患格林－巴瑞症候群（Guillain-Barré syndrome）的個案，不了解疾病的多項治療方式，且現今研究指出各項治療之預後並無差異，進而產生了焦慮及抉擇衝突。如何在醫療團隊的合作下，藉由共享決策引導個案選擇了最符合價值觀及適合的治療方式。護理期間為2019年12月3日至12月30日，筆者藉由觀察、直接照護、身體評估及會談等方式收集資料，運用Gordon十一項健康功能型態評估工具，確立個案主要健康問題為身體活動功能障礙、焦慮以及抉擇衝突。照護過程中依照個案個別性，共擬復健計畫，改善身體活動功能障礙及預防合併症，運用同理心、善意溝通及病情告知方式，深入了解個案對疾病或治療疑慮並給予解答，與醫療團隊合作下運用共享決策，引導個案參與醫療決策，有助於正向態度面對疾病，並減輕焦慮及抉擇衝突。建議醫院整合相關資訊，建立疾病決策輔助工具，令共享決策更普及運用臨床上，進而提升醫療品質，也建議設立神經內科個案管理師，提供疾病諮詢管道，並藉由病友會舉辦，互相分享經驗、相互支持，持續追蹤個案後續恢復狀況，提供完整照護。

This article described the nursing experience of caring a patient with Guillain-Barré syndrome (GBS) who showed uncertainty regarding the medical treatments and anxiety regarding decision-making. The nursing period was from December 3rd to December 30th, 2019. The author collected data through observation, direct care, physical assessment, and interviews, and used Gordon’s eleven health function assessment tools to establish the main health problems, which included physical activity dysfunction, anxiety, and decision conflicts. In the care process, a comprehensive rehabilitation plan was planned to improve physical activity dysfunction and prevent comorbidities. Individualized care was given during the period and shared decision-making was used to provide him with accurate medical information and a better understanding of the disease, generating a positive attitude towards illness. Through caring and mental support, a good nurse-patient relationship was established. In this way, his feelings of alienation were resolved, stress and anxiety were reduced, psychological barriers were overcome. It is recommended that care givers integrate relevant information and establish disease decision-making aids to make shared decision-making more accessible to patients to to improve quality of care.

1. 吳佩玲, P. L.,劉月敏, Y. M.(2018)。一位罹患格林巴瑞氏症候群新住民婦女的護理經驗。臺灣腎臟護理學會雜誌，17(2)，26-39。
   連結：
2. 林佳蓉, J. R.(2019)。照護一位格林巴瑞症候群個案之護理經驗。彰化護理，26(2)，70-82。
   連結：
3. 許雅紋, Y. W.,伍碧琦, P. C.,吳曉芸, S. Y.(2015)。一位格林巴瑞症候群青少女之護理經驗。志為護理─慈濟護理雜誌，14(2)，98-108。
   連結：
4. 陳思穎, S. Y.,陳玠伊, C. Y.,彭靖舒, T. J.,楊淑君, S. J.,方基存, J. T.,周宏學, H. H.,唐婉如, W. R.(2018)。醫病共享決策以 Three talk model 為例。臨床醫學月刊，81(6)，342-347。
   連結：
5. 蔡姈砡, L. Y.,林秋菊, C. C.(2015)。運用共享決策於一位腎癌併皮下轉移病人之照護經驗。護理雜誌，62(3)，89-94。
   連結：
6. 謝瑞雪, J. H.,王韵宜, Y. Y.(2018)。運用羅氏適應理論於一位格林巴瑞症候群併呼吸訓衰竭患者之加護經驗。長庚護理，29(4)，623-632。
   連結：
7. Hughes, R.A.C.,Swan, A. V.,Van-Doorn, P. A.(2014).Intravenous immunoglobulin for Guillain-Barré syndrome.Cochrane Database of Systematic Review
8. Lehmann, H. C.,Hartung, H. P.,Horste, G. M.,Kieseier, B.C.(2008).Plasma exchange immune mediated neuropathies.Current Opinion in Neurology,21(5),547-554.
9. Ortiz-Salas, P.,Velez-Van-Meerbeke, A.,Galvis Gomez, C. A.,Rodriguez, Q. J.H.(2016).Human immunoglobulin versus plasmapheresis in Guillain-Barre syndrome and myasthenia gravis: a meta-analysis.Journal of Clinical Neuromuscular Disease,18(1),1-11.
10. Saad, K.,Mohamad, I. L.,Abd-El-Hamed, M. A.,Tawfeek, M. S.,Ahmed, A. E.,Abdel Baseer, K. A.,El-Shemy, A. S.,El-Houfey, A. A.,Tamer, D. M.(2016).A comparison between plasmapheresis and intravenous immunoglobulin in children with Guillain–Barré syndrome in Upper Egypt.Therapeutic Advances in Neurological Disorders,9(1),3-8.
11. 車先蕙, H. H.,盧孟良, M. L.,陳錫中, H. C.,張尚文, H. C.,李宇宙, S. W.(2006)。中文版貝克焦慮量表之信效度。台灣醫學，10(4)，447-454。
12. 許菀玲, W. L.,吳淑慧, S. H.,何秀玉, H. Y.(2016)。運用 Watson理論於一位 Guillain-Barré Syndrome 患者及其主要照顧者的護理經驗。高雄護理護理，33(3)，73-84。
13. 陳麗萍, L. P.,武香君, H. C.,劉怡, Y.(2017)。以 Watson 理論運用於格林巴瑞症候群病人之護理經驗。高雄護理雜誌，34(3)，138-149。