飲食行為修正方案運用於血液透析患者之護理經驗

The Nursing Experience of Diet Behavior Modification Project in A Hemodialysis Patient

本文描述一位長期血液透析愚者，因不遵從飲食限制而造成體液電解質不平衡之護理經驗。護理期間為2006年5月20月至2006年8月30日，筆者利用透析患者每週一、三、五下午到院透析時間進行觀察、會談、整體性評估後，以「跨理論模式」為基礎，運用其核心概念中的五個改變階段評估及十項策略技巧應用，逐步引導個案對飲食限制的認知而達到飲食修正行為。根據此模式，飲食限制行為的改變是階段性、循序漸進的過程，每一個改變階段利用特定的策略技巧，並配合個案平日飲食行為來依序改變以達到行為修正的目的。而成功地控制體液電解質在正常範圍內，持續三個月以上。由此經驗顯示，以跨理論為基礎的修正行為應用於不遵從飲食限制的個案有很大的幫助，單一種口頭方式的護理指導對長期透析息者之遵從度影響有限，要改變認知行為必須透過一套具有明確架構及有效的模式來引導個案，以達到最理想的健康狀態。This article describes the nursing experience of caring a long term hemodialysis patient who suffered from fluid and electrolyte imbalance due to poor diet compliance. The nursing period was from May 20,2006 to August 30,2006. The author performed integral evaluation by observing and interviewing with patient every Monday, Wednesday and Friday during hemodialysis sessions. By using multi-theory model and its core concept's five stages change evaluation and 10 strategy skill application, the author gradually improved the knowledge of diet control and achieved modification of dietary behavior. According to this model, the change of self-control dietary behavior is a gradual, stepwise process. It's necessary to use specific strategy and skill in every adjustment stage and select strategies according to patients ordinary dietary behavior in order to achieve the goal of correcting the patient's behavior. The patientfluid status and electrolytes maintained within normal limits for 3 months. This experience showed that it is of great help to use multi-theory model to correct the behavior of patients with poor diet compliance. Using oral nursing instruction as the only strategy has limited effect to the compliance of long term hemodialysis patients. In order to change patients' behavior and achieve ideal health status. We need a set of clear-cut and effective model to instruct the patients.