專科護理師在醫病共享決策的角色：以偏鄉醫院心衰竭個案為例

Role of Nurse Practitioners in Shared Decision Making: Examples of Heart Failure Patients in Rural Hospital

醫療自主權於現今醫療環境中日趨重要，以病人為中心照護的重要環節，就是鼓勵病患積極參與醫療決策，以提升照護品質與滿度度。台灣衛生福利部自2016年開始推行醫病共享決策（shared decision making, SDM），期望促使病人積極參與醫療決策，以提升醫病關係、醫療品質及病人安全。推動至今，共享決策已廣泛運用於臨床實務中。但是，偏鄉及高齡長者，其就醫習慣、喜好、價值觀和醫療新知取得與都市居民有極大的差異。傳統以「醫生」作決策的觀念深植，參與SDM之意願以及推廣策略，值得探討。因此，本文將從專科護理師之角色去探討共享決策於偏鄉醫院推動影響因素，推行過程所遇到困境與經驗，綜整考量偏鄉居民特質及觀念，因應出不同之SDM推行之道。

The importance of patient autonomy is increasing in current complex medical environment as well as the promotion of patient-centered care. One key aspect of patient-centered care is to encourage patients to actively participate in medical decision-making in order to improve the quality and sat-isfaction of care. Since 2016, the Ministry of Health and Welfare of Taiwan has promoted shared decision-making (SDM), aimed at facilitating patient participation in medical decision-making and enhancing doctor-patient relationships for medical quality and patient safety. Since then, SDM has been widely applied in clinical practice. However, rural and elderly patients have significant deviations from urban residents in their health-seeking habits, preferences, values and access to medical informa-tion. The traditional concept of “doctor” as sole decision maker is deeply rooted in rural and elderly patients’ mind, and their willingness to participate in SDM and how to promote it are worth exploring. Therefore, the aim of this paper is to discuss from nurse practitioners’ point of view of about the chal-lenges and factors that influence the experiences of the implementation of SDM in rural hospitals. The results of this synthesis will contribute to proper implementation of SDM in low health literacy areas in the future.