照顧一位意外事故失能者因安置方式產生決策衝突個案之護理經驗

Experience of Nursing a Person who Became Disabled Following an Accident and Handling Placement Decisional Conflicts

本文為一位因外出發生車禍導致輕中度失能之65歲個案，希望返家照顧，但因家屬間對於安置問題意見不一，因此擔憂成為家人負擔，不敢表達真實想法，對於安置問題周旋不定，而產生決策衝突，筆者深刻感受個案無助，引發筆者探討動機，護理期間自2020年07月20日至2020年8月8日，筆者以觀察、病歷查閱、身體評估及直接護理等方法，藉由觀察、會談、身體評估等方式收集資料，並運用Gordon十一項健康功能型態評估工具進行整體性評估，確立身體活動功能障礙、無望感及決策衝突等健康問題。組成跨團隊合作由各專科介入改善個案身體活動功能；透過傾聽、陪伴、尋求家庭支持改善無望感受；使用醫病共享輔助決策工具幫助個案了解各項返家照護之優缺點，最終確定並申請長照2.0醫療服務，審核期間個案先返家由照顧服務員照顧。建議院內在完善決策輔助工具同時，也能增加使用教學課程及分享執行案例，以便能快速熟悉，並在此類病人入院時應即時評估及照會出院準備小組介入。

This paper presents a case where a 65- year-old individual who became mildly to moderately disabled following a car accident; the patient longed for home care, but his family members disagreed with him in terms of his placement. The patient was hesitant about expressing his true thoughts because he worried about becoming a burden to the family. Placement uncertainties caused decisional conflicts. The author deeply emphasized with the patient’s helplessness and decided to study the case further. During the nursing period from July 20, 2020 to August 8, 2020, the author applied methods of observation, medical record review, physical assessment, and direct patient care for data collection. Gordon's Eleven Functional Health Patterns framework was used for holistic assessment and identification of health problems such as impaired physical mobility, sense of hopelessness, and decisionmaking conflicts. To improve the patient’s physical activity function, cross-team cooperationand intervention across various medical sectors were conducted. Through listening, providing company, and seeking family support, the patient’s sense of hopelessness was mitigated. Patient decision aids were used to help the patient understand the advantages and disadvantages of each home care service. Finally, the Long-term Care Plan 2.0 was finalized for application. During the application review period, the patient returned home to be taken care of by a resident care attendant. The hospital was advised to improve the patient decision aids, offer more related courses, and share case examples to quickly familiarize patients with patient decision aids. When such patients are admitted, the hospital should conduct assessment and inform the discharge planning team on a timely basis.