運用醫病共享決策於一位年輕中風病人出院準備之護理經驗

Applying Shared Decision-Making in the Discharge Planning of a Young Patient With Stroke: A Nursing Experience

本文為運用醫病共享決策模式，協助一位年輕缺血性中風病人面對後續復健能力及出院準備產生焦慮之護理經驗。照護期間為2023年7月10日至7月31日，運用Gordon十一項功能型態評估，藉由照護、觀察、會談及查閱病歷等方式進行資料收集，確立主要健康問題為：「身體活動功能損傷」、「自我照顧能力不足」及「焦慮」。筆者運用醫病共享決策模式之步驟，鼓勵參與並比較不同決策差別，進而評估其價值及期望，共同擬定後續復健及出院計畫。於護理期間提供相關指引及復健方式，並協同物理及職能治療師，共同依照病人作息習慣、喜好及期望制定復健計畫；與病人探討身體受損下，共同設計適合及改善日常生活功能之動作步驟，以增進日常生活自主能力；並提供出院後續復健選擇之決策輔助工具，鼓勵探討影響選擇後續出院復健因素，最終依照自我期望及目標選擇急性後期照護復健計畫，並增進出院後自我安排復健能力，以減緩對未來之不確定性及焦慮，進而期許未來回歸社會及執業能力，期望藉此護理經驗供臨床參考。

This article describes the experience of a nurse in applying the shared decision-making process to assist a young patient with ischemic stroke to address their anxiety, commence post-stroke rehabilitation, and formulate an appropriate discharge plan. The patient’s information was collected during the nursing period from July 10th to July 31st, 2023 through interviews, observation, chart reviews, and comprehensive nursing assessments using Gordon’s eleven functional health patterns. The three major nursing diagnoses included:“impaired physical mobility”,“insufficient self-care ability”, and“anxiety”. The SHARE model developed by the Agency for Healthcare Research and Quality was subsequently employed to build a relationship based on shared decision-making. We encouraged patient participation in comparing different decision options, assessing their values and expectations, and formulating rehabilitation and discharge plans. Also, relevant rehabilitation guidance methods were provided in cooperation with physical and occupational therapists. A personalized rehabilitation plan was designed based on the patient’s daily routines, preferences, and expectations to optimize their ability to perform key activities of daily life. With regard to the discharge plan, we assisted the patient to choose their continuing rehabilitation preferences by providing patient decision aids. Finally, the patient chose the post-acute rehabilitation care plan based on self-determined expectations and goals, which helped alleviate uncertainty and anxiety about the future. This nursing experience aimed to improve the confidence of a young patient with stroke in post-stroke rehabilitation by applying a shared decision-making model. We hope to share this nursing experience as a reference for medical staff responsible for caring for other young patients recovering from stroke.