一位血友病病人參與自我照顧之護理經驗

Self-Care Experiences of a Patient with Hemophilia

本文描述一位血友病病人參與自我照顧之護理經驗。照護期間為2018 年9 月10 日至9 月14日，病人因疾病認知不足及心存僥倖，於侵入性檢查前未主動告知病史且未預防性注射凝血因子，導致鼻腔血流不止。護理過程中發現病人害怕注射、無規律回診及對疾病照護一知半解，故引發筆者收案動機。藉由觀察、傾聽、會談與直接照護等收集資料，以整體性護理評估為架構，確立病人有舒適障礙、知識缺失、焦慮之健康問題。護理過程提供減輕鼻出血及腫脹之舒適照護，增進睡眠與休息；運用醫療團隊合作，指導並修正疾病認知，進一步學習注射凝血因子之技能；應用多媒體影片，鼓勵病人參與手術醫療決策，並共同擬訂復健運動計劃以減輕焦慮。建議未來能進階資訊化病歷系統，定期追蹤管理血友病病人回診、居家注射及復健運動之成效，進而提升醫療品質，藉此經驗分享照護此類病人之參考。

This article described the self-care experiences of a patient with hemophilia. The nursing care period was from September 10th to 14th, 2018. The patient did not proactively inform nurses of his medical history and receive prophylactic injection of coagulation factors prior to an invasive examination due to his insufficient knowledge of the disease and excessive optimism. These resulted in an uncontrolled epistaxis after the examination. During the process of hospitalization, healthcare providers found that the patient was afraid of injection, did not visit the hospital on a regular basis, and was unfamiliar with corresponding disease management. Therefore, the healthcare providers decided to conduct further investigation in this patient. Patient’s health information was collected through observation, listening, discussion, and direct patient care. Based on an overall nursing assessment, the patient was confirmed to suffer from several health-related issues, including impaired comfort, knowledge deficit, and anxiety. Nursing interventions were taken to reduce nosebleeding, alleviate swelling, and improve quality of sleep and rest. With the collaboration of medical teams, the patient was given insightful instruction on disease-related knowledge and received training on skills of self-administration of coagulation factors. Healthcare providers also employed multimedia videos to encourage the patient to engage in the decision-making process of surgical intervention. Furthermore, the medical teams and the patient jointly laid out a plan on rehabilitation to alleviate his anxiety. In the future, we suggest that healthcare organizations advance their electronic medical record systems, which enable healthcare providers to track patients with hemophilia regarding their follow-up inspections, injection behaviors, and rehabilitation. Caregivers who attend to such patients may wish to refer to this case report.