照顧一位單親媽媽不遵從血液透析醫囑個案之護理經驗

Nursing Experience of Caring for a Single Mother Not Complying with the Hemodialysis Medical Advice

本文是探討一位 25 歲單親媽媽不遵從血液透析醫囑之護理經驗。護理期間自民國 100 年 10 月 29 日至 100 年 11 月 30 日，經由身體評估、觀察及會談技巧收集資料，運用 Gordon 十一項健康功能進行護理評估，確立個案有：不遵從、體液容積過量、角色扮演改變等護理問題。筆者在護理過程中，採以主動關懷的方式與個案建立良好的護病關係。並以客觀的角度和個案討論未能按時配合透析治療，水分控制不遵從行為，以及分析規律透析的優點與重要性，在共同解決排斥透析的原因後，已能坦然面對透析治療。此外指導個案記錄每日體重變化與水分控制方法，個案已改掉愛喝飲料的習慣，且體重控制在可增加範圍內。並運用同理心引導其表達自身感受，協助找回透析後生活之重心及休閒活動與興趣，以提升個案自我照顧能力，間接也減輕單親媽媽面對慢性疾病之壓力。期望藉由此護理經驗提供血液透析護理人員做為臨床照護之參考。

This article is about the nursing experience of a 25-year-old single mother on hemodialysis that did not comply with her doctor’s medical advice. The nursing period was from October 29, 2011 to November 30, 2011. Information was collected using physical evaluation, observation and interview the a nursing assessment made using Gordon’s 11 Health Functions. The following patient problems were identified: non-compliance, excess fluid and change in role. During the nursing process, the author actively took care of the patient to build a good relationship. The author also discussed objectively the result of not cooperating with dialysis treatment and water control with the patient, and analyzed the advantages and importance of regular dialysis. Eventually, we helped her come to terms with dialysis treatment. The patient was directed to record her weight every day and to control her water intake. The patient stopped having drinks and kept her and kept her weight in the normal range. Using empathy, I encouraged the patient to express her feelings, pick up her life again and become interested in leisure activities. This improved her self-care ability and also reduced the pressure of facing chronic disease as a single mother. I hope this nursing experience will provide a useful reference for dialysis nurses in clinical care.