運用自我調節理論於一位血液透析患者血磷控制之護理經驗

Nursing Experience of Applying Self-Regulation Theory to Control Phosphorus Levels in a Hemodialysis Patient with Hyperphosphatemia

本篇個案報告為運用自我調節理論於一位血液透析病患血磷控制之護理經驗。照護期間自96年9月10日至96年12月10日，藉由觀察、會談、病歷查閱等方式收集資料，經七次會談及三次電話訪談，結果顯示個案有血磷控制相關行為問題。筆者以自我調節理論為概念架構設計血液透析患者血磷控制方案；透過血磷控制方案的行為改變，指導個案學習自我監測，主動記錄飲食與藥物日誌，自我分析血磷上升的原因，並針對欲解決問題設定目標，執行血磷控制相關策略，使個案感受自我的進步與改變，提升自我效能，以維持成功的血磷自廔管理，進而預防併發症。筆者期望藉此個案報告，能提供臨床護理人員照護此類個案之參考。

This report describes the nursing experience of applying self regulation theory to help a hemodialysis patient with hyperphosphatemia. From September 10(superscript th) to December 10(superscript th), 2007, a behavior modification protocol for controlling phosphate intake was designed and applied to the patient, and data collection was done through observation and interview. We first instructed the patient on how to review the dietary and drug intake. Then self-monitoring on behavior related to the problem of phosphate control was done by recording detailed information on a working booklet. Factors which might cause an increase of serum phosphate level were analyzed and identified, and an adjustment on behavior based on the results of analysis, was made. This action enhanced the self-efficacy and led to an increased desire and effort to achieve the preset goal. This case report might serve as a reference in guiding nurses on how to provide appropriate nursing interventions to help patients with similar problems, and to launch a clinical program for patients with hyperphosphatemia in hemodialysis centers.