運用醫病共享決策照護一位反覆吸入性肺炎病人之護理經驗

A Nursing Experience of Applying Shared Decision-Making to A Patient with Recurrent Aspiration Pneumonia

10.6692/KJN.202104_38(1).0006

楊鎮宇(Cheng-Yu Yang)；楊曉菁(Hsiao-Ching Yang)；陳姮卉(Heng-Hui Cheng)

吸入性肺炎 ； 醫病共享決策 ； 氣切 ； aspiration pneumonia ； shared decision-making ； tracheostomy

高雄護理雜誌

38卷1期（2021 / 04 / 01）

62 - 71

繁體中文

背景：本文為描述一位吸入性肺炎反覆入院插管治療個案之照護經驗。目的：個案因多次入院對本身及家屬帶來不少衝擊及疲倦，個案因困難脫離呼吸器，面臨氣切抉擇而出現焦慮，引發照護動機。方法：於2017/11/14至12/31期間藉由觀察及會談等方式收集資料，並藉用羅氏適應模式評估個案，發現存在焦慮、照顧者角色緊張、潛在危險性肺吸入等問題，並運用醫病共享決策步驟（SHARE）協助執行醫療決定。結果：介入後個案終完成氣切且成功脫離呼吸器，另照顧者壓力及灌食技巧不當，致反覆吸入性肺炎，透過了解需求，共同擬訂符合需要之護理措施，並在持續指導下能正確執行照護技巧。結論：個案終透過護理，身、心及社會皆獲妥善照顧，期藉此經驗，作為護理人員日後照護之參考，擬定個別性計畫、執行個人化措施，發揮護理獨特功能。

Background: This article describes the care experience of a patient with aspiration pneumonia who had been repeatedly hospitalized for intubation. Purpose: Multiple admissions had made a great impact on the patient and the family. Due to the difficult extubation and the tough decision to pursue tracheostomy, the patient had become extremely anxious. These phenomena motivated the authors to conduct this project. Methods: By observation and interviews between 2017/11/14 and 12/31 and using the Roy Adaptation Model to evaluate the patient, problems such as anxiety, a nervous caregiver, and potentially dangerous lung aspiration were discovered; therefore, SHARE protocol was used to help the patient make the appropriate decisions. Results: After intervention, the patient was extubated successfully in the following days. Besides, through understanding the demand and jointly formulating the necessary care measures and continuous guidance, the caregiver could develop the right skills for patient care to prevent aspiration pneumonia caused by caregiver stress and improper feeding skills. Conclusions: Ultimately, the patient's body and mind were placed at ease through proper nursing care. It is hoped this experience including individual plans and personalized measures could be used as a reference for future nursing care.