運用共享決策於一位格林- 巴瑞症候群個案之照護經驗

Using Shared Decision-Making on a Patient with Guillain-Barrésyndrome: A Care Experience

本文探討一位罹患格林-巴瑞症候群（Guillain-Barrésyndrome）的個案，不了解疾病的多項治療方式，且現今研究指出各項治療之預後並無差異，進而產生了焦慮及抉擇衝突。如何在醫療團隊的合作下，藉由共享決策引導個案選擇了最符合價值觀及適合的治療方式。護理期間為2019年12月3日至12月30日，筆者藉由觀察、直接照護、身體評估及會談等方式收集資料，運用Gordon十一項健康功能型態評估工具，確立個案主要健康問題為身體活動功能障礙、焦慮以及抉擇衝突。照護過程中依照個案個別性，共擬復健計畫，改善身體活動功能障礙及預防合併症，運用同理心、善意溝通及病情告知方式，深入了解個案對疾病或治療疑慮並給予解答，與醫療團隊合作下運用共享決策，引導個案參與醫療決策，有助於正向態度面對疾病，並減輕焦慮及抉擇衝突。建議醫院整合相關資訊，建立疾病決策輔助工具，令共享決策更普及運用臨床上，進而提升醫療品質，也建議設立神經內科個案管理師，提供疾病諮詢管道，並藉由病友會舉辦，互相分享經驗、相互支持，持續追蹤個案後續恢復狀況，提供完整照護。

This article described the nursing experience of caring a patient with Guillain-Barrésyndrome (GBS) who showed uncertainty regarding the medical treatments and anxiety regarding decision-making. The nursing period was from December 3rd to December 30th, 2019. The author collected data through observation, direct care, physical assessment, and interviews, and used Gordon’s eleven health function assessment tools to establish the main health problems, which included physical activity dysfunction, anxiety, and decision conflicts. In the care process, a comprehensive rehabilitation plan was planned to improve physical activity dysfunction and prevent comorbidities. Individualized care was given during the period and shared decision-making was used to provide him with accurate medical information and a better understanding of the disease, generating a positive attitude towards illness. Through caring and mental support, a good nurse-patient relationship was established. In this way, his feelings of alienation were resolved, stress and anxiety were reduced, psychological barriers were overcome. It is recommended that care givers integrate relevant information and establish disease decision-making aids to make shared decision-making more accessible to patients to to improve quality of care.