運用Orem理論提升一位糖尿病腎病變透析病人自我照顧能力之護理經驗

Nursing Experience with Using Orem Self-care Theory to Improve the Condition of a Patient with Diabetic Nephropathy on Hemodialysis

糖尿病導致末期腎病的病人在接受血液透析治療過程中，須承擔自我照顧重大責任，因此提升病人自我照顧能力是主要的護理職責。本文運用Orem自我照顧理論，照護一位糖尿病腎病變接受血液透析之個案，護理期間為2008.04.24-2009.02.20，筆者藉由會談、觀察、傾聽及直接照護個案的過程收集資料，進行生理、心理、社會與靈性之整體性評估，確立有體液容積過多、潛在危險性感染、知識缺失、社交隔離之護理問題，並給予完全代償性護理、部分代償性護理、支持與教育性護理措施，透過專業諮詢與護理指導，提供正確性相關訊息及個別性的護理活動，使個案獲得更多了解和認知，增強自我照顧意願及技巧，坦然面對疾病改變並遵循醫療處置，協助解決個案將治療整合到日常生活中，重拾其信心並提升自我照顧之能力，以達到持續性與整體性的照護。

Patients with end-stage diabetic nephropathy must take responsibility for self-care during hemodialysis treatment making the promotion of patient self-care a primary goal in care giving. This article applies Orem's theory to a new hemodialysis ESRD patient between April 24, 2008 and February 20, 2009. Data was collected through interviews, observation, attentive listening and direct care of the patient with Orem's self-care deficiency theory used to assess the patient's physiological, psychological, social and spiritual well-being. Health problems such as excess body fluid, potential danger of infection, deficiencies in knowledge and social isolation were also identified. Orem's Nursing System, including the wholly compensatory system, the partially compensatory system and supportive education were used to provide professional care and education. Better rapport and understanding with the patient was finally achieved through a health education program offering massages and consultations. Ultimately, continuous and holistic care was realized through the patient overcoming his anxiety, enhancing his self-care abilities, restoring his self-confidence and an improved quality of life.