一位初次血液透析病患治療計畫知識缺失、無力感、哀傷之護理經驗

Nursing experience with first-time hemodialysis patient experiencing treatment plan knowledge deficit, powerlessness and grief

本文旨在探討一位慢性腎衰竭患者接受初次血液透析治療面臨治療計畫知識缺失、無力感及哀傷之護理經驗。護理期間為 2010 年 6 月 25 日至 8 月 5 日。筆者運用觀察、會談、傾聽、身體評估及查閱病歷等方式，收集身體、情緒、智能、社會及靈性等五大層面之護理問題，確立個案主要的健康問題為治療計畫知識缺失、無力感及哀傷。護理過程中運用個別性護理措施以提供個案及家屬血液透析及透析導管自我照顧知識與腎病飲食衛教，鼓勵學習相關技能以提昇個案之疾病照護知識及自我控制感、適應血液透析之新生活。同時運用主動關懷、傾聽及同理心給予個案及家屬心理支持與鼓勵，陪伴個案度過失去至親的哀傷過程。期望藉由此護理經驗，提供臨床護理同仁在照護此類病患之參考。

This case report describes the nursing experience with a patient with from chronic renal failure undergoing hemodialysis for the first time powerlessness that experienced treatment plan knowledge deficit, powerlessness and grief. During the nursing period from June 26 to July 2nd in 2010, the author used observations, interviews, physical examinations and review of medical records to identify nursing issues in the five key dimensions: body, emotion, intellect, society and spirituality. Major nursing problems identified included: treatment plan knowledge deficit, powerlessness, and grief. The application of individual nursing intervention during the nursing process educated the patient and her family on self-care of dialysis and dialysis catheter as well as proper diets for kidney disease. We encouraged the patient to learn skills that helped with caring for her disease and self-control in order to adapt to a new life with hemodialysis. At the same time, the author utilized active caring, listening and empathy to provide psychological support and encouragement to the patient and her family. The author also helped the patient cope with the grieving process after the loss of a loved one. The nursing experienced provided in this report should help nursing personnel with similar cases.