運用互動照護模式照顧一位慢性阻塞肺病長者不遵從醫療指導之護理經驗

Nursing Experience of Using the Interactive Care Model on a Chronic Obstructive Pulmonary Disease (COPD) Elderly Patient who Noncompliance the Medical Instruction

本文探討運用互動照護模式改善一位85歲慢性阻塞性肺病患者不遵從醫療指導的護理經驗。筆者自2019年4月19日至2019年5月1日，運用Gordon十一項健康功能型態評估，藉由觀察、陪伴傾聽、身體評估等方式收集資料，發現個案主要護理問題有：1.不遵從／與缺乏動機、照顧者能力不足有關，2.體液容積過量／與心臟輸出量降低導致體液滯留有關，3.低效性呼吸型態／與呼吸無力、痰液無法有效清除有關。考量個案年長特質，筆者以互動照護模式為架構設計護理措施，包括：集點遊戲、床上腳踏車、圖畫式輸入輸出單、數字卡胸腔分區叩擊活動，並提供影音光碟合併回覆示教，最終使個案病情恢復並順利返家。本文建議照顧年長慢性病個案時，以互動照護模式為架構提供護理措施，有助個案及其家屬瞭解並遵從指導，期望此護理經驗提供護理人員未來照顧類似個案時參考，以降低慢性病患反覆再入院率。

This article described the nursing experience of using the interactive care model (ICM) to improve an 85-year-old COPD patient who was not compliant with the medical instruction. The author provided care from April 19, 2019 to May 1, 2019. By using Gordon’s 11-item functional health pattern assessment and collecting data by observation, companionship, listening, physical assessment, and so on, the following main problems in nursing were identified: (1) non-compliance and lack of motivation, which were associated with the caregiver’s insufficient care ability; (2) fluid volume excess, which was associated with reduced cardiac output, resulting in fluid retention; and (3) breathing pattern (ineffective), which was associated with weak respiratory function and failure to effectively clear sputum. Considering the characteristics of an elderly patient, the author used an interactive care model as the framework to provide relevant nursing activities, including the bonus point game, the bicycle training in bed, a record of intake & output by pictures, the digital card to learn chest percussion skill, and video learning combining repeatedly teach-back. Finally, the patient was discharged and returned home. This article suggests the use of interactive care model as the framework to provide nursing activities for elderly patients with chronic illnesses, which may help patients and their family understand and comply with care instructions. The nursing experience herein may serve as a reference for nursing personnel to care for similar patients in the future and to reduce readmission rates of patients with chronic illnesses.