運用Omaha系統提供一位社區老人在居家環境與處方用藥上安全應用之護理經驗

The Nursing Experience in Management of Medication and Home Environment Safety for a Community Elderly by Applying the Omaha System

本文為描述運用Omaha系統提供社區老人在居家環境與處方用藥上安全應用之護理過程。照護期間由2009/06/23-08/05，以實際社區家訪及電話追蹤訪問與個案及家屬建立互動信賴關係，並運用Omaha系統做為護理評估工具完成個案健康評估，了解個案目前所面臨的問題與需求。評估結果顯示個案護理問題有：「安全：潛在危險性跌倒」、「藥物作用及副作用：潛在危險性損傷」、「營養不均衡，多於身體所需」、「藥物諮詢及管理建立：缺乏有效的溝通管道」共4項，並在護理措施上應用：一、提昇「安全維護」的知識及環境改善預防跌倒；二、增強「預防藥物交互作用產生及自我察覺副作用警訊」自我能力的提昇；三、提供「飲食控制∕營養飲食攝取建議與限制」之相關建議；四、提供「藥物諮詢、管理建立」方法，其中因個案在處方用藥使用上已造成健康威脅，更是首要需立即處理的護理健康問題。本文藉由提供適當的護理措施後，除增進健康照護知識協助社區長者獲得安全的居住環境及處方用藥外，亦促進個案獲得良好生活品質。因此，期望本文能提供專業人員，在評估及照護社區老人居家環境及用藥安全之參考。This article describes the nursing experience in management of medication and home environment safety for a community elderly by applying the Omaha system from June 23rd to August 5th of 2009, the author developed mutual trust relationship with elderly and family by regular home visiting and telephone interviews. The comprehensive health assessment was based on the Omaha system. The assessment result showed that the nursing health problems included 'Safety: Risk for Falls', 'Medicine Effect and Side Effect：Risk for Injury', 'Nutrition Imbalanced: More Than Body Requirements', and 'Medicine Consultation and Management Development: Lack Effective Communication'. Nursing interventions included 'to educate patient knowledge about environment safety and fall prevention', 'to enhance self awareness about medication side effect', 'to provide information regarding diet and nutrition intake', and 'to advocate strategies about medication management'. The first priority for this patient would be the safety medication used. The author provided nursing interventions to enhance knowledge of health promotion in order to promote safety environment and medication used and improve the quality of life. Hopefully, this article can provide information concerning assessment and promote safety home environment and medication used for other nursing staff.