以歐倫自我照顧理論護理一位血液透析患者之經驗

Nursing Experience of Caring for a Hemodialysis Patient by the Application of Orem's Theory

末期腎病是不可逆的慢性病之一，而血液透析是末期腎病患者目前主要的治療方式，對一位初面臨血液透析的患者而言，在生理、心理及日常生活必然遭受很大的衝擊，因此要如何協助患者從容、適時的面對透析治療，及扮演好自我照顧的角色，將是刻不容緩的。本個案報告主要在探討一位末期腎病患者接受血液透析的護理經驗。照護期間為91.10.18-92.01.31，筆者運用會談、觀察、傾聽等技巧收集資料，並採用歐倫自我照顧理論來評估，發現患者有體液容積過量、知識缺失及社交隔離等健康問題。透過衛生教育提供相關訊息，並經由共同討論及病友經驗分享，來協助解決患者生理上的問題，克服心理障礙，使患者能提昇自我照顧能力，重新建立信心，改善生活品質。

End-stage of renal disease (ESRD) is one of the most progressively chronic diseases. The primary treatment for ESRD is hemodialysis. Patients who first face hemodialysis encounter many conflicts from physical, psychosocial, and daily activities dimensions, so it is urgent to help the patients adopt a proper role and an easy method for dealing with the hemodialysis. This case report discusses the nursing experience of a new hemodialysis ESRD patient. The author used interview, observation, and attentive listening to collect data, and adopted Orem's self-care deficiency theory to assess the patient, and found that the patient had other health problems including excess body fluid, lack of knowledge of self-care of hemodialysis, and social isolation (or separation). Through a health education program offering massages, discussions and peer group counseling to share the experience; the patient finally could solve her physical problem, and overcome the knot in her heart, enhanced her self-care abilities, rebuild her confidence, and improved her quality of life.