運用記憶法教導一位高血鉀血液透析患者之經驗

Experience with using the mnemonic system to teach a patient in hyperkalemia hemodialysis

本文主旨為探討照護一位血液透析之老年期女性個案，因知識不足而面臨高血鉀問題，主要照護期間為 100 年 1 月 31 日至 100 年 4 月 30 日，個案曾因知識不足造成高血鉀入住加護病房，經由詳細的評估瞭解個案飲食習慣皆為含鉀量過高飲食，個案常表示衛教內容太多且繁瑣，需要學習的內容記不住，為避免高血鉀情況惡化，在護理過程運用發現個案主要護理問題呈現為：潛在危險性損傷／高血鉀。筆者以簡易心智量表（mini-mental state examination）測試個案，發現個案有輕度認知功能障礙，便運用創新思維將記憶法融入傳統衛教內容中，於個案透析時間運用會談技巧並使用記憶法中的聯想法、故事記憶法及諧音法引導個案輕鬆學習，增強個案對高鉀飲食的概念及應對方法，使用簡單的記憶法教學，讓個案不需刻意背誦即能輕鬆記憶，訓練過程約 4 週時間，以四次學習測試作為評值，個案於 2 月 21 日第一次測試，由僅能記得 2 項水果名稱，經由記憶法不斷練習可在 3 月 28 日第四次測試中達到預期之 7 項水果，且對高鉀飲食有基本認知，此教育訓練過程可讓個案行為改變，將學習效果運用在生活中，減少高血鉀食物攝取，進而改善高血鉀造成不適之症狀增加其生活品質。

"The purpose of this research was to investigate the case of an aged female hemodialysis patient suffering from hyperkalemia due inadequate knowledge of health and hygiene. The main care period was from January 31 through to April 30 in 2011 when she was hospitalized due to hyperkalemia. Careful evaluation found that the patient’s diet was too high in sodium because she found the content of health education to be too much and too complicated to remember. As a result, she was placed in the intensive care unit to control her condition. A complete nursing assessment was performed on physiology, self-concept, role function and interdependence adaptation trends. The main nursing problem was identified to be “Risk for Perioperative-Positioning Injury and hyperkalemia”. The author tested the patient using the Mini-mental state examination (MMSE) and found that the patient suffered from mild cognitive impairment. To help the patient remember the hygiene and health knowledge, a creative mnemonic system was introduced into the traditional content of hygiene and health knowledge. The association method, mnemonic story method, homophonic method and conversation skills were utilized while the patient underwent hemodialysis to make learning about high-sodium foods and how to avoid them easier. No rote memorization was required as well. The training took place over a 4-week period and was assessed through four learning tests. The first test took place on February 21 and the patient remembered only two fruits. By practicing the mnemonic system however, she reached the goal of memorizing seven fruits during the fourth test on March 28. The patient also achieved a basic understanding of the hyperkalemia diet as well. The education and training changed the patient’s behavior, and the knowledge learnt was used in the patient’s everyday life to reduce the intake of foods that induce hyperkalemia. As a result, discomfort from hyperkalemia was reduced and the patient’s quality of life improved."