DAISY nurse March 經國敏盛 吳佳昀Wu Jia-Yun

呼吸照護中心裡充滿著長時間依賴呼吸器、臥床的患者。他們的眼前多是一片白花花的天花板。在呼吸照護中心裡工作六年的佳昀，照護著如此的患者，肩上扛著重重的責任，讓我們的病患活得更好，無論是生理、心理，還是靈性上，用一股滿腔的熱忱來照護我們的病患。

有位年約70多歲的病患，因腦中風而長期臥床，平時病患大大小小的事都由女兒照顧，此次因腦血管再度嚴重栓塞，而住進呼吸照護中心，其病況一直都不樂觀，僅能維持病人的生命徵象，在接近臨終時，醫師表示只能盡人事並與其討論是否要施行心肺復甦術，他女兒因無法接受病患即將離開，決定積極急救，而在佳昀與其女兒會談的過程中，了解到母女間彼此依賴著對方，女兒沒有結婚，生活重心都在母親身上，現在即將失去心裡的支柱，當佳昀一一回答女兒的問題，了解了女兒的困境，協助其在有限時間及空間中，營造母女相聚的時光，為病患設想出一些提高舒適度的措施，護病關係從此建立起。經多次的溝通，她了解到「既然無法改變就試著放下吧!如果只因不捨，讓母親在最後要離開的階段，受那麼多的折磨，放手或許對病患也是一種慈悲的解脫」。最後，她選擇放手了，病人在家人的陪伴下，安靜、祥和有尊嚴的離開，女兒接受了病患的離開。

佳昀從事護理工作的理念，是以維護病患的尊嚴及舒適為中心，以個人最大的力量為半徑，又涵蓋了家屬的立場，來照護病患。她的表現符合了敏盛體系的核心價值:

■『誠信』：

1.達成病患或家屬要求。

2.可自我要求於時限內完成單位業務。

3.堅持遵守單位內規定與制度。

■『創新』：

1.擔任單位護品組組長，制定單位各項品質監測計劃，協助監測及推動各項護理品質計劃。

2.擔任單位副護理長，制定單位年度各項在職教育，推動各項護理在職教育。

3.擔任護理部護理教育委員，推動各項護理部在職教育及進階業務。

■發展：

1.於在職期間完成元培科技大學之學業。

2.99年主動參與護理部舉辦行政訓練課程，99年晉升為單位副護理長。

■卓越：

1.與病患及家屬建立起良好護病關係，發現病患及其家庭之困難，提供適當資源。

■分享：

1.擔任單位臨床教師、輔導新進人員、護生，具教學熱忱與耐心，協助適應。

2.能配合護理部之臨時人力調度，主動協助支援其他單位人力。

Nurse Wu Jai-Yun worked on the ventilator care unit for 6 years.  The patients are all long term chronic respiratory dependent patients.  Most of these patients are unresponsive and they stare blindly in the white ceiling every day and that may be the only thing they see day in and day out.  Typically the nurse's duty can also be mundane and repetitious.  But to nurse Wu, she sees her job is to not only take good care of the patients physically with compassion and enthusiasm but also provide emotional and spiritual support to the patients and their family.

She once had to attend to a 70 years old female patient who was ventilator dependent, and bed ridden after a severe stroke. Her condition wasn’t stable and the outlook was not too optimistic. The patient relied on machines to maintain her vital signs, and her primary caregiver was her daughter.  When the physician discussed the DNR option for her mother, her daughter refused and insisted on aggressive resuscitation instead. 

While interacting with the patient’s daughter, Nurse Wu Jia-Yun realized that there was a strong bond between the daughter and her mother. The daughter was not married and her mother was her life’s only focus. Losing her mother would mean lose her motivation for other things.  Understanding the situation, Nurse Wu Jia-Yun made exception to the visiting-hours limitation, hence increasing the time available to the daughter to care for the patient.  Ms. Wu also made efforts to improve the comfort level of the patient, by relieving her pain and providing spiritual support.  Through interaction, she soon developed a very good relationship with the patient’s daughter. Ms. Wu helped the daughter cope and grieve. The patient’s daughter began to understand that since nothing could be done that would improve her mother’s condition, letting go may be the best way to relieve her mother from suffering. She eventually accepted the DNR option for her mother, and the patient passed away surrounded by her family in peace and dignity.

For Nurse Wu Jia-Yun, the core of good patient care is to maintain the patient’s dignity and improve his or her comfort during illness.  The scope of care is also extended to the patient’s relatives.  She demonstrated the core values of Min-Sheng Healthcare Network in:

■ Honesty：

1. Complete duties within timeframe.

2. Follow hospital and department policies and procedures.

■ Originality：

1.Involved in quality indicator monitoring, and in various quality improvement projects.

2. Involve in developing nursing continuous education.

■ Progression：

1. Pursued further academic degree while working at the same time.

2. Voluntarily attended nursing administration training course and was promoted as the deputy head nurse of the respiratory care center in 2010.

■ Excellence：

1. Proactively identifies patient and family needs/difficulties and provides recourses and support.

2. Patient and family satisfaction.

■ Sharing：

1. Is a clinical mentor and teaches new staff and nursing students; she is viewed by others as enthusiastic and a patient mentor.

2. Willing to cover extra shifts and support other units when there’s a staffing shortage.

Daisy nurse Feb. 經國總院吳秀梅護理師Wu Show-Mei

    自學校畢業後，即邁入臨床病房工作13年之久，對護理的熱忱度是與日俱增。在VIP病房服務多年期間，每一天都秉持著真誠服務的心，努力照護關心不同疾病的個案。秀梅深深體會到『金錢不是萬能，健康才是真正的財富！』一段真實案例：

    慈哥是從事某公司的高級長官，育有一子，入院時才發現已是癌症末期且多處轉移，且不適合手術。雖然勉強表現出積極勇敢面對的態度，但是身為主護的秀梅已從個案的眼神和家庭互動中，發現其實慈哥心中始終牽掛放不下其妻和未成年的兒子。在多次細心照護(協助教導身體清潔、翻身拍背、肢體活動)和主動噓寒問暖下，已建立良好護病信任感。同時也搭起一座溝通的橋樑，在牧師的陪伴下，引導個案和家屬表露心中的想法和對於未來的規劃。主護秀梅秉持正向的力量，鼓舞個案誠實面對人生的態度。雖然慈哥最終仍不敵命運的安排，秀梅最後發揮專業引領執行遺體護理，一路陪伴其走完人生最後的旅程…

    秀梅從事護理工作的理念，秉持著敏盛的核心價值『HOPES』，提供五心級「愛心」、「耐心」、「關心」、「用心」、「真心」的服務，將南丁格爾的精神發揚光大。

■『誠信』：

1.盡忠職守於本院任職達9.5年。

4.具有成本概念，確實計價無漏帳。

5.護理記錄書寫確實完整，亦能主動教導同仁。

6.經常針對問題提出正向思考的看法與意見。

■『創新』：

1.98年參與院內品管圈活動-『甜甜圈』，主題活動：提升病房護理人員交班完整性，榮獲全院第二名。

2.99年協助推動健康指導海報競賽，榮獲護理部第二名。

■發展：

1.參與各項在職教育，如婦產科、兒科次專科訓練、師資培訓、感控、品管相關課程。

2.參與護理部舉辦行政訓練課程，99年晉升為單位副護理長。

■卓越：

1.99年4月起護理部舉辦「關懷天使票選活動」，獲單位出院病人票選結果， 

  分別於5月、7月、8月、9月、10月、11月、12月蟬連冠軍。

2.99年度獲出院病人書面讚揚次數共計52次，獲院方記嘉獎四次。

■分享：

1.擔任單位臨床教師，輔導新進人員和二年期學員，具教學熱忱，深獲人員喜愛和信賴。

2.能配合單位臨時人力調度，並支援其他病房人力。

3.主動推動環境清潔與安全，99年單位榮獲全院5S競賽活動第二名

Ms. Wu Show-Mei has been working as a nurse ever since she graduated from school 13 years ago. Her passion for this career grew as her experience increased.  Nurse Wu Show-Mei is now assistant nurse manager on the “VIP ward” (the unit that receives private-pay patients) where she has served for several years. From her daily clinical service, she has come to realize that sincerity and compassion are essential for good patient care. She also clearly understands that “Money is not everything” and that “Health is the greatest wealth.”

Here is an example from a real story:

Mr. Tzu was a senior executive at a company.  He was admitted to the hospital with end-stage cancer, and because the disease had spread throughout his body he couldn’t undergo surgery.  Although he has accepted his fate and try to face positively in the impending death, his primary nurse Ms. Wu soon realized that Mr. Tzu’s was consumed with worries on the future of his wife and young son. Nurse Wu  built a good and trustful nurse-patient relationship with Mr. Tzu and his family. She facilitated a pastor upon patient's request to provide spiritual support to the patient and his family, and encouraged him to reflect on his life honestly. Thanks to her efforts, the patient was not afraid of death anymore, he felt at peace with himself and was able to express his feeling toward his family openly. After Mr. Tzu passed away, Nurse Wu assured the patient had proper wrapping of his body and accompanied Mr. Tzu and his family in the final journey of his life.

Nurse Wu meets Nightingale’s spirit of helping people with passion, patience, caring, attentiveness, and respect. She also reflects the core values of Min-Sheng’s Network through:

■ Honesty：

1.          Has worked in this hospital for 9.5 years, therefore expressing her loyalty.

2.          Pays attention to cost and expenses and never charges the patient wrongly.

3.          Documents care in nursing notes accurately and thoroughly.

■ Innovation：

1.          In 2009, her quality improvement project of “enhancing inter-shift communication” won the 2nd prize in the hospital-wide competition.

2.          In 2010, her patient education poster won the 2nd prize in the nursing department competition.

■ Progression：

1.          Actively attends ongoing educational programs, such as specialty trainings of OB/GYN and Pediatrics, mentor program, infection control and quality improvement.

2.          Completed nursing administration training and was promoted to assistant nurse manager in 2010.

■ Excellence：

1.          Selected as the “best nurse of the month” by patients in May, July, August, September, October, November, and December of 2010.

2.          Received 52 compliment letters from patients after discharge in 2010.

■ Sharing：

1.          As a clinical teacher, she provided instruction to new staff and nursing students, she is loved and trusted by her trainees.

2.          She is willing to cover extra shifts and support other units when there’s a staffing shortage.

3.          Proactively increased level of cleanliness and safety in the care environment and won the 2nd price in the hospital wide competition.

Min-Sheng Hospital is very fortunate to have such a fine nurse providing direct care to the patients at the hospital.

DAISY nurse Jan. 大園敏盛 彭淑梅Peng Shu Mei

近年來社會貧富差距愈加顯著，因此不難想像現實生活中有許多弱勢家庭需要協助，下述個案(阿秀阿姨與李叔叔)就是一個典型的案例。

99.07.13~99.12.28）護理措施包含：

阿秀阿姨中風後呈現植物人狀態，李叔叔對她不離不棄，義無反顧的排除萬難將她接回家中照護，初次接觸到李叔叔時，他無助的眼神撼動人心，在那眼神中，流露出他的悲哀與不捨。彭員在居家護理專業介入這個家庭過程中，努力將居家護理與個案管理的角色作串聯，扮演著溝通者、諮詢者、協調者與傾聽者的角色，安排醫師訪視，引導團隊人員腦力激盪，共同思考著如何提供更適切的、個別性的照護。在照護期間（

1.          與家屬(案夫、案母、案子、案弟)共同召開討論會，鼓勵家屬陳述家庭現況中的問題與困境，並討論適切的社會資源。

2.          評估個案照護需求，經家屬同意後予以轉介非公部門（慈濟功德會）社會資源，取得氧氣製造機、噴霧器等輔具資源，成功的教導家屬儀器的使用及清潔與保養。

3.          引導醫師在訪視過程中，評估照顧者壓力負荷問題，團隊人員適時給予心理支持，並對家屬的付出與努力給予口頭肯定及讚賞。

4.          與某基金會的社工師聯繫，通報此個案，尋求安置照護。

5.          個案返院做健康檢查時(安置機構所需的例行性檢查)，團隊人員主動尋找資源（民間救護車），減輕家屬的經濟負擔。

6.          協助案夫做生命回顧，適切表達肯定之意，鼓勵用正向態度面對人生。

經過一番努力，這個家庭終於能撥雲見日，現在阿秀阿姨安置在某基金會所成立的機構照護，李叔叔不捨之情雖猶存，在我們的鼓勵下，已能轉念學會「放下」，現在的他有份穩定的工作，一有空就去探視太太。

彭員在照護這個案、家庭中表現的是：護理不僅是執行常規的工作而已，多用一份心，不但可以讓個案的到更適切的照顧，也照顧到他的家人及家庭；也讓同仁學習到：在工作中需提醒自己學習「反思」，讓自己的護理工作注入「新」與「心」的感動，真實的體驗到護理的專業與價值也能夠多面向的去發揮。

彭員的表現：就體系的核心價值『HOPES』，對個案及家屬用心的照顧，協助解決問題及獲得信任，其為『誠信HONESTY』的展現，運用她居家護理的專業，整合醫療團隊的照護及社會資源的使用，為『卓越EXCELLENCE』的居家護理服務；另將此依經驗注入許多的感動，與同仁共同體驗護理專業與價值，為『分享SHARING』的成長

Although Taiwan enjoys a vibrant economy, pockets of poverty still exist and families among minority groups still need help to survive. Mr. and Mrs. Lee are typical examples.  Mrs. Lee had been in coma and in the vegetated stage after a stroke and being cared for by her husband at home for months.  Ms. Peng Shu-Mei RN, a home care nurse and case manager for the Lee family, played an important role of being a communicator, counselor, moderator, and listener.  During July 13^th to December 28^th 2010, nurse Peng Shu-Mei arranged physician home visits for Mrs. Lee, but also proactively led the care team to brainstorm and tried to figure out the best way to provide more appropriate and individualized care.  Here are some examples of her great work:

1.          The patient’s need is not the only concern for Ms. Peng.  She tried to identify the problems of the whole family by interviewing the patient’s husband, mother, son and brother.  She encouraged the entire family to express their concerns and difficulties and helped to obtain resources from the community.

2.          After identifying family’s financial difficulty, Ms. Peng helped the patient obtain a free O2 concentrator machine, a nebulizer, and other medical devices, and educated the family members about the usage, cleaning, and maintenance of those devices.

3.          During home visits, Ms. Peng also discovered the pressure and psychological burden of the primary caregiver.  She provided adequate mental support and encouragement for Mr. Lee.  She assisted Mr. Lee to do “life review” about Mrs. Lee.  By doing so, she encouraged Mr. Lee to build a positive attitude toward life.

4.          She proactively contacted social service that helped located a charity long term care center that can take ventilator patient.

5.          She obtained free ambulance for the patient's transport to the center, helping to lighten the family’s financial burden even more.

Thanks to Nurse Peng’s efforts, now Mrs. Lee has settled down in a charity institution.  Mr. Lee was able to get a job and can still visits Mrs. Lee very often.

Details matter.  Ms. Peng distinguished herself by paying close attention to the plight and taking care of the whole family of the patient, and not only conducting routine nursing works.  Nurse Peng has been an employee of Min-Sheng Health System for 12 years.  She has constantly take care the patient and family in an exceptional manner and performed beyond her job responsibilities.  She has consistently gone out of her to helping others.  She deserves the DAISY award because she met the MS health care core values of trust, professionalism, innovation, excellence, and sharing.  Her performance inspired other nurses, and reminded other nurses the reason for choosing nursing as a profession, which is to be the guardian to the patient and family.