醫病共享決策降低骨科病人術後自我照顧之焦慮

Reducing Anxiety in Orthopedic Postoperative Patients Self Care through Shared Decision Making

術後傷口照顧方式、自我照顧能力與手術部位感染息息相關。提升病人自我照顧能力，有助於促進生活品質、減少住院、降低罹病率及死亡率。經現況分析發現有51.6%骨科術後病人對於傷口自我照顧有中高程度焦慮，主要原因為缺乏衛教教材、無法自主選擇傷口照顧方式、對於敷料知識不足、不好的傷口照顧經驗、自我照顧信心不足、沒有親友可以協助照顧。透過增加敷料種類、在職教育、運用醫病共享決策提供病人參與照護決策及自我照顧衛教影片等方式，將術後傷口自我照顧焦慮情形，由51.7%降至16.2%，病人對衛教滿意度，由75.0%提升至93.8%。本專案運用醫病共享決策及多元策略衛教模式讓骨科病人及其家屬與醫療團隊一起討論術後傷口照顧方式，進而改善病人對於術後傷口照顧體驗。

The relationship between postoperative wound care, self-care ability, and surgical site infections is of paramount importance. Enhancing patients' self-care abilities not only fosters an improved quality of life but also leads to reduced hospitalization rates, and lower morbidity and mortality rates. A recent analysis revealed that 51.6% of postoperative orthopedic patients experience moderate to high levels of anxiety concerning wound self-care. The principal factors contributing to this anxiety include the dearth of educational materials, limited autonomy in selecting wound care methods, inadequate knowledge about dressings, negative past wound care experiences, low self-care confidence, and a lack of familial or social support. By implementing various strategies, such as broadening the array of dressings, providing on-the-job education, employing shared decision-making between patients and healthcare providers, and disseminating self-care educational videos, the incidence of postoperative wound self-care anxiety significantly decreased from 51.7% to 16.2%. Additionally, patients' satisfaction with educational interventions surged from 75.0% to 93.8%. This project ingeniously adopted shared decision-making and an all-encompassing health education approach, fostering interactive discussions among orthopedic patients, their families, and healthcare teams regarding postoperative wound care techniques, ultimately enhancing the overall patient experience with wound care.