從否認到接受：一位重覆入院初次洗腎病患之護理經驗

From Denial to Acceptance: The nursing experience of a patient who was readmitted for her first hemodialysis

本文是照護一位老年末期腎病病患，從拒絕動靜脈廔管植入到症狀加劇反覆入院，最後接受洗腎的照護過程。護理期間從97年1月7日至2月5日。照護期間確立個案主要護理問題為：體液容積過量、皮膚搔癢引起不適、洗腎知識缺失、潛在危險性感染等。筆者除了提供一般初期洗腎病患的護理外，曾多次與個案會談、主動關懷並使用自行設計之動靜脈廔管模型說明洗腎的原理，增加個案及家屬對血液透析的認識，終能增加個案對洗腎的正確認知進而願意接受血液透析治療，期望藉此個案報告提供給臨床醫護人員參考。從否認到接受洗腎對病患而言，是個身心社會皆受衝擊的過程，唯有個別性提供適合病患的護理活動，才能協助病患接受洗腎治療，並協助病患適應未來長遠的洗腎生活。

The case report presents the nursing experience of a patient who was readmitted for her first hemodialysis. The elderly female patient refused to accept an A-V shunt when she was diagnosed with End-stage Renal Disease (ESRD). She was forced to accept hemodialysis treatment after she suffered from deterioration symptoms related to ESRD. The care period was from January 7th to February 5, 2008. The author was the primary care provider of the patient. The health problems of the patient accessed and analyzed by the author were “excess bodily fluid”, “pruritus”, “lack of hemodialysis-related knowledge” and “high risk for infection”. In addition to providing routine nursing care, the author interviewed the patient several times and provided care for her. Furthermore, the mechanism and process of hemodialysis were clearly explained to the patient using a self-designed device made by the author. The patient finally felt much more comfortable about continuing hemodialysis treatment. The author would like to share the experience with other clinical professionals. Other professionals can use the author’s comprehensive experience to help patients with ESRD to continue with hemodialysis treatment and better adapt to their long-term physical and psychosocial problems.