成功運用 Watson 關懷理論於一位血液透析個案之護理經驗

Applying Watson’s Theory to Caring for a Hemodialysis Patient

本篇是分享照護一位末期腎病初期接受血液透析治療之經驗，筆者於 98 年 2 月5 日至 5 月 15 日護理期間擔任主責護理師角色，藉由直接照護、觀察、會談、溝通及整體性身體評估等技巧，收集個案生、心理、社會及靈性方面健康問題，發現個案有營養狀況少於身體需要、焦慮、無望感問題，筆者運用 Watson 關懷理論概念為基礎，採主動關懷態度及同理心建立良好護病關係，教導個案進食前漱口，建議充分用餐時間方法、給予鼓勵和轉移注意力，提供放鬆技巧，鼓勵個案表達感受，細心問候陪伴及協助獲得相關護理資源，學習自我照顧能力，透過持續的關懷及接納等技巧，協助個案調適及渡過此階段，逐步重建正向的生活態度，激發個案自信心及希望、恢復往日生活型態。鑑於末期腎病個案日漸增加且九成以上個案接受血液透析治療，冀望此次成功護理經驗與護理人員分享，作為日後照護此類個案參考。

This report describes nursing care experience with a patient undergoing hemodialysis for end stage renal disease between February 5, 2009 and May 15, 2009. The author served as the patient’s primary care nurse and applied Watson’s concern theory to guide the care plan. The patient’s physical, psychological, social and spiritual issues were assessed via observation, interview, and physical exam. After analysis, the author identified healthcare issues related to malnutrition, anxiety and hopelessness. Active caring and empathy was used to build a positive patient-nurse relationship. The patient was then taught to use mouth rinse before eating, to take his time with the meal, given encouragement and diversions, taught about relaxation techniques, encouraging the patient to express his feelings, inquiring after the patient’s condition, helping the patient acquire nursing resources, and learn how to care for himself. Through continuous care and acceptance, the patient eventually adapted and accepted this period before rebuilding a positive approach to life, inspiring self-confidence and hope, and returning to his old way of life. As the number of end stage renal disease (ESRD) patients are now growing and over 90% must undergo hemodialysis, we have shared this successful nursing experience with other nursing personnel to serve as reference on caring for ESRD patients.