運用Watson關懷理論照護老年多重共病症心衰竭病人之護理經驗

Nursing Experience in Providing Care for Older Adult Patients with Multiple Comorbidities and Heart Failure Using Watson's Theory of Caring

10.6740/NTUHJN.202401_20(1).0004

黃詠萱(Yung-Hsuan Huang)；高子媗(Zi-Xuan Gao)

焦慮 ； 心輸出量減少 ； 多重共病症 ； 心衰竭自我管理 ； Watson關懷理論 ； Anxiety ； decreased cardiac output ； multiple comorbidities ； self-management of heart failure ； Watson's theory of caring

臺大護理雜誌

20卷1期（2024 / 01 / 01）

28 - 39

繁體中文;英文

心臟衰竭是一項慢性疾病，當同時合併多重共病症及心理問題，將連帶影響病人生活品質，若未接受良好醫療處置及充分自我管理，不僅預後差，死亡率也相當高。本文針對一位合併有心房顫動、慢性阻塞性肺病、慢性腎臟病等多項共病症的老年心衰竭個案，於2022/3/25至2022/4/1，藉由Watson人性化關懷理論，透過同理與傾聽、主動陪伴並鼓勵心肺復健、提供心衰竭疾病、飲食與運動等衛教知識及出院後復健資源，並以電訪追蹤個案出院後生活情形，評估並鼓勵個案持續落實自我照護行為，處理個案「心輸出量減少、活動無耐力、焦慮」等健康問題，緩解其生理及心理不適，提升個案之預後及自我管理能力，使個案於出院後能與心衰竭和平共存。期許本文能提供護理人員運用Watson關懷理論個別性給予心衰竭病人四大層面全人照護之經驗，並建議可舉辦心衰竭衛教活動，促進病人與家屬了解整體疾病及自我照護措施，護理人員則可運用簡易評估工具快速評值，再針對不足之處給予個別性衛教，以提供最有效率且適切的護理。

Heart failure is a chronic disease that can significantly affect the patient's quality of life when accompanied by multiple comorbidities and psychological issues. Without proper medical treatment and self-management, prognosis can be poor, with high mortality rates. This article presents a nursing experience in caring for older adult patients with heart failure and comorbidities such as atrial fibrillation, chronic obstructive pulmonary disease, and chronic kidney disease. Watson's theory of caring was applied from March 25, 2022, to April 1, 2022, including empathetic listening, proactive companion and encouragement for cardiac rehabilitation, health education on heart failure, diet, exercise, and post-discharge rehabilitation resources. Follow-up through phone calls assessed and encouraged the patient's adherence to self-care behaviors; addressed health issues such as decreased cardiac output, limited physical activity tolerance, and anxiety; alleviated physiological and psychological discomfort; and improved the patient's prognosis and self-management abilities to coexist with heart failure after discharge. This article aims to provide experiences to nursing personnel in utilizing Watson's theory of caring to deliver four-dimensional holistic care to patients with heart failure and suggests organizing heart failure education activities to enhance patients' and families' understanding of the disease and self-care measures. Nursing personnel can also use simple assessment tools for rapid evaluation and provide individualized health education that targets deficiencies to ensure effective and appropriate care.