照護一位血液透析患者併有自殺行為之護理經驗

Nursing Experience of Caring for a Hemodialysis Patient with a Suicide Attempt

本文是探討一位長期血液透析病人，害怕他人知道自己洗腎而受到歧視，再加上日常飲食及生活社交活動無法隨心所欲，認為自己活著是家人的累贅進而喪失生存意念，筆者於 2010 年 09 月 23 日至 11 月 16 日期間，經由直接照護、傾聽等方式收集資料，並運用 Gordon 所提出的十一項功能性健康型態進行評估。確立個案有無效性因應能力、社交互動障礙、營養狀況改變：少於身體需要等健康問題。照護過程中，透過心理諮商、主動關懷、傾聽內心的感受與想法，提供血液透析照護上的相關知識，協助正向的面對透析病程的發展，增加適應透析後的生活；藉由家庭、社會支持、宗教力量和腎友交流，找到自我價值與自信，勇敢並主動與親戚朋友互動，建立正常的社交生活；同時會診營養師，提供營養諮詢及飲食計劃，來滿足個案的營養需求。運用個別性的護理過程，提供心理支持，協助個案正向的面對疾病與相關問題，適時並找出合適的因應方式，同時減少了個案自殺的想法。

This article shares the experience of nursing a patient that attempted suicide due to the changes from becoming a chronic kidney diseases patient needing long-term renal replacement therapy. These included fears of discrimination from being a dialysis patient, inability to maintain his premorbid diet and social activities, as well as becoming a burden to his family members. The clinical data of the patient were obtained via direct patient care, physical evaluation and interviews between September 23 and November 16, 2010. The collected data was analyzed using Gordon’s 11 Functional Health Patterns. Evaluation revealed problems such as poor adjustment, social dysfunction, and nutritional deficiency due to dietary change. We used a multidisciplinary approach including counseling by a clinical psychiatrist as well as diet education and evaluation by a dietician to accommodate his individual dietary needs. We taught the patient the knowledge about dialysis to help him face the dialysis course positively and adapt to the life with dialysist. Family support, religion, and other dialysis patient were also enlisted to help the patient rediscover his self-esteem and selfconfidence so he could socialize with family and friends once again. Personalized nursing care was used to provide active caring, listening and emotional support to help the patient cope with his illness and related problems. Finding the right response at the right time also made the patient feel less suicidal.