協助一位慢性腎臟疾病患者接受腎臟替代療法準備之護理經驗

Experience in Nursing: Helping a Chronic Kidney Disease Patient to Accept Renal Replacement Therapy

本文乃描述一位羅患慢性腎臟病之獨居女性患者，獲知因慢性腎臟疾病進展須及早接受腎臟替代療法選擇與準備，同時必須面對終身疾病所帶來的身心與社會壓力之護理經驗。護理期間為2007年10月8日至2008年2月10日，筆者以觀察、會談、病歷查閱及電訪收集資料，並運用Gordon十一項健康功能型態為評估工具，確立個案有無望感、抉擇衝突、潛在危險性感染、社會支持的缺乏等主要健康問題。照護過程中筆者與個案建立良好的護病關係，提供身、心及社會方面的支持與資源，協助個案選擇適當的腎臟替代療法，並及早完成動靜脈廔管建立後，指導廔管照護的方法，透過提供相關疾病治療訊息，減輕未來須終生接受血液透析而產生負面情緒等調適過程，使個案重獲希望，能運用社會福利資源，發展良好的支持系統來面對經濟、壓力等問題，終至回復正常的社交生活，提升個案之生活品質，以正向的態度面對未來與透析共存之新生活。

This case report describes the nursing care experience with a single female chronic kidney disease (CKD) patient facing the need for renal replacement therapy as well as the physiological, psychological and social stress associated with a lifelong chronic illness. The data was collected through observation, direct interview, telephone interview, physical assessment and chart review during the care period between October 8, 2007 and February 10, 2008. The Gordon 11-item Function Health Pattern Assessment Method was used to assess health problems including hopelessness, confliction about decision-making, risk of infection, and lack for social support. By building a positive Nurse-Patient relationship with the patient, the author was able to provide physical/psychosocial resources and support to the patient, help the patient prepare and care for the vascular access, and to provide full information about renal replacement therapy (RRT). Through an integrated and continuous nursing care program, the patient accepted and received RRT. Nursing intervention helped the patient cope with the negative emotions from having to undergo hemodialysis, helped the patient regain hope as well as make use of social welfare resources to develop a strong support system to deal with the physical, psychosocial, and economic stress. The focus of CKD care is not limited to only applying scientific knowledge in the physical area but also using the multiple supportive systems to meet the individual's psychosocial and economic needs.