協助一位透析病患面對心臟手術壓力之護理經驗

Nursing Care of a Dialysis Patient Receiving Cardiac Surgery

本篇個案報告，是探討一位長期透析病患，因併發冠狀動脈疾病，面臨接受心臟手術之壓力與衝擊，護理期間自90年9月28日至90年11月20日，過程運用Gordon十一項健康功能評估，並藉由直接護理、觀察會談等方式收集資料，加以分析整理。個案因面臨手術之壓力，其健康問題包括：焦慮、急性疼痛、身體心像改變、特定知識缺失。筆者在護理過程當中採傾聽、同感心、介紹相似個案及鼓勵予以心理支持。主動關懷身體舒適、協助維持生理功能及讓家人支持使及重獲信心，及提供相關諮詢及資料，讓個案對居家自我照顧有深一層的認識。在護理人員協助及各方支持之下，終於使個案能安然渡過疾病過程，並接受手術後生理改變的事實，對疾病有正向之經驗。

This case report is based on a study from the nursing experience of helping a long-term dialysis patient who combined with coronary heart disease, facid the stress of cardiac surgery. From September to November 2001, Gordon's 11 items on life functions were used to assess this patient's needs. Data were collected through observation, interview, and direct nursing care. We found that the patient's health problems included anxiety, acute pain, change in body image, and knowledge deficit. The primary nurse used listening and empathy skills to support the patient, introduced other patients who had similar experience to share their experiences, provided physical care to maintain the patient's physical function, provided information regarding post-operative change and care, and involved family member in the caring process. Through the above nursing care process, the patient could keep a positive attitude toward the changes caused by the operation and had a smooth operation experiences.