照顧一位初次罹患肺結核服藥不遵從患者之護理經驗

Nursing Experience of Caring for a Medication Noncompliance Patient with Newly Diagnosed Tuberculosis

本文為照顧一位初次罹患肺結核服藥不遵從患者之護理經驗，護理期間自2016年2月19日至3月28日，筆者運用Gordon十一項健康功能型態評估為工具，經自身體評估、觀察、會談及病歷查閱方式收集資料，於護理過程中發現個案有營養少於身體需要、不遵從、焦慮及社交隔離等問題。照護過程與個案建立治療性人際關係，以傾聽、有效溝通，鼓勵表達其感受，並利用衛生褔利部疾病管制署結核小影片觀賞、問答集來增加個案對疾病的認知：設計「藥物紀錄表」、「心情日記」、鼓勵參與健康照護行為來增進個案控制感；鼓勵攝取高熱量、高蛋白及維生素，利用國民健康局「食物及營養手冊」，瞭解一日之適當攝取量，並教導製作陳皮山楂飲品及用茶葉漱口以減少噁心感，增加食慾；最後，提供支持團體分享心情，安排單位團體衛教及病友座談會，給予正向支持及鼓勵，使個案重拾信心及希望。照護過程中不只著重於疾病衛教或解決生理上的問題，更要著重於心理層面，協助個案以健康的態度，面對未來的生活。建議護理人員除了依據照護標準提供衛教之外，應評估個案之個別性，設計符合個案需求的照護措施。且未來護理人員的在職教育可增加心理評估、溝通、諮商技巧及專家經驗分享，加強工作人員心理照護層面的知能。期望藉由照顧此個案的經驗，能與同業分享。 This article describes the nursing experience of caring for a medication noncompliance patient with newly diagnosed tuberculosis. One of the authors took care of this patient from February 19 to March 28, 2016. Guided by Gordon's 11 Functional Health Patterns, patient's information was collected via physical assessment, observation, interviews and patient's healthcare document. Imbalanced nutrition: less than body requirements, noncompliance, anxiety, and social isolation were identified as the patient's health problems. The nurse built therapeutic interpersonal relationships with the patient, and constantly applied active listening skills to encourage the patient to express his feelings. Watching to the Tuberculosis Video, reading Question-and-Answering section provided by Centers for Disease Control, Ministry of Health and Welfare, Taiwan, to help the patient to increase the understanding of the disease. The nurse also encouraged the patient to participate his own health care activities by noting down medication taking list and writing diaries to enhance disease management. Encouraging the patient took high calories, high protein and vitamins food and to learn about the adequate daily portions followed by the guidance of ＂Food and Nutrition Handbook＂ published by Health Promotion Administration, Taiwan. In order to diminish nausea and increase appetite, the nurse taught the patient and his families to make tea by using dried citrus skin or tea leaves. Additionally, the nurse arranged patient education program and introduced support group to share information, provide psychological support and encouragement to regain confidence and hope. Taking care of the patient both physically and psychologically, the nurse helped the patient to view his future life positively. It is recommended that nurses not only provide health care, but also need to assess the patient's individuality to provide appropriate interventions. The nursing in-service education program should include patient's psychological assessment, communication and counselling skills and experience sharing from experts to enhance the nurse's competencies. We hope to share this experience with the nurse who faces the similar situation.

This article describes the nursing experience of caring for a medication noncompliance patient with newly diagnosed tuberculosis. One of the authors took care of this patient from February 19 to March 28, 2016. Guided by Gordon's 11 Functional Health Patterns, patient's information was collected via physical assessment, observation, interviews and patient's healthcare document. Imbalanced nutrition: less than body requirements, noncompliance, anxiety, and social isolation were identified as the patient's health problems. The nurse built therapeutic interpersonal relationships with the patient, and constantly applied active listening skills to encourage the patient to express his feelings. Watching to the Tuberculosis Video, reading Question-and-Answering section provided by Centers for Disease Control, Ministry of Health and Welfare, Taiwan, to help the patient to increase the understanding of the disease. The nurse also encouraged the patient to participate his own health care activities by noting down medication taking list and writing diaries to enhance disease management. Encouraging the patient took high calories, high protein and vitamins food and to learn about the adequate daily portions followed by the guidance of ＂Food and Nutrition Handbook＂ published by Health Promotion Administration, Taiwan. In order to diminish nausea and increase appetite, the nurse taught the patient and his families to make tea by using dried citrus skin or tea leaves. Additionally, the nurse arranged patient education program and introduced support group to share information, provide psychological support and encouragement to regain confidence and hope. Taking care of the patient both physically and psychologically, the nurse helped the patient to view his future life positively. It is recommended that nurses not only provide health care, but also need to assess the patient's individuality to provide appropriate interventions. The nursing in-service education program should include patient's psychological assessment, communication and counselling skills and experience sharing from experts to enhance the nurse's competencies. We hope to share this experience with the nurse who faces the similar situation.