一位C型肝炎患者初次接受干擾素合併Ribavirin治療之護理經驗

Nursing Experience with a Patient with Hepatitis C Viral Infection Receiving Peginterferon Plus Ribavirin Therapy for the First Time

本文乃探討照護一位C型肝炎初次接受干擾素合併Ribavirin治療的個案，因面臨要決策藥物治療的過程中感到困擾以及接受藥物治療後所衍生不良反應之護理經驗。護理期間為2010年2月11日至2010年8月26日，運用Gordon十一項健康功能型態做為評估架構，經由觀察、會談及傾聽等方式資料收集，分析個案有：焦慮、知識缺失、潛在危險性傷害等健康問題。筆者利用C型肝炎治療照護手冊與醫師共同向個案說明整個治療過程，並邀請兩位成功對抗C型肝炎的病友，分享治療經驗，以幫助個案和家屬對疾病及治療的正確認知，使其減少治療決策困難，進而配合治療以達成治癒的成效。在護理過程中利用門診及電訪與個案建立良好的護病關係，藉由個別性的護理措施提供整體性、連續性的評估與照顧，同時給予關懷、鼓勵、陪伴與支持，以增加個案對治療的自信心及面對治療不良反應時的自我照護能力，以達到積極性治療，提升治療的成功率。期能藉此經驗分享，作為日後護理人員臨床照護之參考。

This article summarizes the care of a patient with hepatitis C viral infection who received peginterferon plus ribavirin treatment for the first time. The nursing experience included helping the patient to decide whether or not to receive the treatment and how to manage the adverse reactions arising from that treatment. The nursing period was from February 11, 2010 to August 26, 2010. Information was gathered by observation, interview and listening. Utilizing Gordon’s eleven functional health patterns as a reference, the nurse found that the patient had three major health concerns: anxiety, lack of knowledge, and potential risk of harm. The nurse used ‘treating hepatitis C care manual instructions’ to explain the entire treatment process to the patient. She invited two hepatitis C patients who had been successfully treated to share treatment experiences with the patient to help correct misunderstanding about the disease and its treatment in order to achieve a sustained virological response. Through outpatient visits and telephone interviews, the nurse developed a good relationship with the patient. With individual nursing measures, she provided holistic, continual evaluation and caring, as well as concern, encouragement, company and support to increase self-confidence and the ability for self-care in order to face the adverse reactions of treatment, and improve its success rate. Sharing this nursing experience may provide a reference to nursing colleagues who will look after this kind of patientin the future. I would like to address my appreciation to David Lin who has edited and done some translation for this article.