運用共享決策於一位先天性腎上腺增生症初次懷孕婦女之生產方式決策

Application of Shared Decision Making on Birth Choice in a Primigravida Woman With Congenital Adrenal Hyperplasia

本文旨在運用共享決策於一位先天性腎上腺增生症初次懷孕婦女之生產決策。護理期間自2018年1月9日至2018年4月3日，依生理、心理、社會與靈性四大層面，進行整體性的護理評估，歸納孕婦主要健康問題有：焦慮和醫療抉擇衝突的健康問題。護理期間運用以個案為中心的照護模式，利用決策輔助工具於醫病討論，鼓勵表達內心感受，提供個案疾病風險與利益的生產方式及抉擇之完整資訊，以降低焦慮，並協助孕婦做出合宜的生產計畫與選擇，讓孕婦獲得更安全且高品質的照護。在臨床實務上，建議護理人員遇到先天性腎上腺增生症懷孕婦女時，可運用輔助決策工具，協助孕婦做最佳的生產選擇決策。

Shared decision making was used by a primipara with congenital adrenal hyperplasia to make decisions related to her delivery plans and process. The four components of the holistic nursing assessment process (physical, mental, social and spiritual) were conducted by the author from January 9th, 2018 to April 8th, 2018. The major concerns of the subject were anxiety and conflicts related to medical decision making for her health problems. The Case-Centered Care Model and Patient Decision Aids were applied in medical discussions conducted during the period of nursing care. The subject was encouraged to express her feelings during the process. The completed information for the delivery process, including the risks and benefits for the disease, was provided to the subject in order to lower her anxiety, assist her to select the most-appropriate plan for delivery, and ensure high quality, secure nursing care. Using Patient Decision Aids in clinical practice to help pregnant women make the best decisions for their delivery plans is recommended in cases where the patient has congenital adrenal hyperplasia.