照顧一位肺結核老年人服藥不遵從之護理經驗

The Nursing Experience of Medication Noncompliance in the Elderly Patient with Pulmonary Tuberculosis

本文探討一位87歲個案因咳嗽多日、食慾差入院求治卻被診斷為肺結核，在接受肺結核治療期間產生生理、心理衝擊及服藥不遵從之護理經驗。個案擔心得病後會拖累家人被社會排斥，因此抗拒接受隔離及藥物治療。照護期間為2009年9月25日至11月06日，藉由直接會談觀察、身體評估及病歷查閱等方式收集資料，並用Gordon十一項功能性健康型態評估，歸納出個案有服藥不遵從、營養狀況改變：少於身體所需、無望感及社交隔離等健康問題。在護理過程中，筆者運用會談溝通方式技巧來澄清個案對疾病的誤解，並與個案達成藥物認知上的共識，與醫療團隊擬定治療計畫，並提供適合個案之護理照護，包括適時賦予個案主導權與決策力、將家屬納入共同參與督促每天服藥計劃、利用日曆記事本記錄服藥成效等策略，提升個案對疾病治療及藥物遵從性。期望藉由此次經驗，能提供護理人員日後照護類似病人的參考與運用。

The aim of this study was to investigate the nursing experience of the physiological and psychological impacts, and drug compliance during tuberculosis treatment in an 87 y/o patient. The patient worried about the influence of disease and social exclusion in his family. Initially, the patient refused isolation and tuberculosis treatment. The caring period started from September 25th, 2009 till November 6th, 2009. Data were collected from direct interviews, observation, body assessment, and medical records. Gordon’s functional health patterns assessment tool was employed to evaluate non-adherence to medications, altered nutrition status: less than body requirements, hopelessness and social isolation. Through listening, accepting and respecting the patient’s needs, nurses helped the patient by arranging the physician to meet and explaining the treatment progress to the patient and family. With the cooperation with physicians, nurses, dietitians, pharmacists and the tuberculosis case manager, a suitable treatment program was provided. This program increased medication compliance by helping prescription of everyday medication by family, and recording medication time by notebook. This nursing care experience expected to provide the reference for similar patients in the future.