一位中斷治療結核病病人之門診護理經驗

An outpatient nursing experience of a treatment-interrupted tuberculosis patient

10.6692/KJN.201804_35(1).0008

劉姿吟(Tzu-Yin Liu)；陳惇杰(Tun-Chieh Chen)；徐琬茵(Wan-Yin Hsu)

治療中斷 ； 結核病 ； 門診護理經驗 ； treatment-interrupted ； tuberculosis ； An outpatient nursing experience

高雄護理雜誌

35卷1期（2018 / 04 / 01）

92 - 103

繁體中文

本篇個案報告是描述一位服用抗結核藥物中斷治療的門診病人之護理經驗，照護期間自2015年8月21日至2016年3月10日期間之回診時間，運用會談、觀察及查閱病歷記錄等方式收集相關資料，並運用生理、心理、社會及靈性層面進行整體性評估，確立個案有潛在危險性肝臟功能障礙、焦慮、社交隔離之健康問題。筆者於門診照護過程，發揮個案管理師之角色功能，採個別性訪談提供單獨空間維護隱私，讓個案抒發情緒表達內心想法。因個案初期曾經服用抗結核藥物導致肝指數異常，擔心再次服用產生副作用導致無法工作，因此不願意接受治療，也擔心讓其他人知道，害怕會因此疾病遭到排擠，進而產生態度及行為改變，不願與他人互動接觸，後續針對個案運用傾聽、同理心與個案建立良好的治療性人際關係，依健康問題個別性衛教指導，運用開放式溝通及主動關懷引導個案說出焦慮的原因，並且澄清觀念提供正確訊息，並與主治醫師、衛生所護理師互相溝通及配合，協助個案行為改變等方式，提供連續性適切之照護措施，讓個案願意持續接受治療並完成整個結核病療程，期望藉此護理經驗，提供醫護人員日後照護門診及住院之結核病人之參考。

This case report describes an outpatient nursing experience of an anti-tuberculosis treatment-interrupted patient. The nursing care period was between August 21, 2015 and March 10, 2016. The author used interview, observation and chart record reviewing to collect the client's personal information, and evaluated the client globally by bio-psycho-socio-spiritual aspects. The health problems of potential hepatic dysfunction, anxiety, and social isolation were established. The role function of the tuberculosis case manager was displayed by individual interviewing of the client in a private space allowing her to express her own thoughts. The client had experienced anti-tuberculosis agent-induced hepatotoxicity, had worried about the adverse event resulting in her being unable to work, and was therefore resistant to further anti-tuberculosis treatment. She was also worried about the disease disclosure possibly resulting in discrimination and social isolation, so then she became unwilling to interact with others. The author used listening and empathizing to establish good therapeutic rapport with the client and then provided individual education concerning her health problems and guided her to express the cause of her anxiety via open-minded communication and active caring to clarify the incorrect idea of anti-tuberculosis treatment. The author also played the role of coordinator among physician, nurses and the Department of Health to help the client change her behavior and to provide continuing nursing care to encourage the client's compliance throughout the whole anti-tuberculosis treatment course. It is hoped that this nursing experience can provide a reference for other healthcare workers to take care of outpatient or hospitalized tuberculosis patients.