照護一位末期腎臟病患者接受血液透析之護理經驗

Nursing Experience from Care of an End Stage Renal Disease Patient Receiving Hemodialysis

本文旨在描述一位初次診斷為末期腎臟病個案，在面臨身、心理衝擊時，經由護理措施介入後，接受血液透析之護理經驗。護理期間自2008年10月13日至2009年1月19日，於個案門診治療期間，利用會談、觀察、查閱病歷及電訪等方法收集資料，並運用Gordon十一項健康功能型態與身體評估為工具。確立個案主要護理問題為營養少於身體所需、無望感、睡眠型態紊亂、抉譯衝突。藉由個別的護理指導提供整體性、連續性照護，改善個案口腔異味和調整三餐烹調方式，以促進食慾來降低疾病所引起的營養問題；主動關懷、陪伴、傾聽及告知治療方式，以減輕對疾病治療的疑慮及心中的焦慮，透過支持系統，增加個案的自信心以面對未來；教導放鬆技巧及穴道按摩，幫助個案改善睡眠品質；運用團隊照護，提供腎臟替代療法相關資料，安排實際參訪透析室，介紹病友分享經驗，協助個案接受並選擇適當的替代模式。在一切周全準備下，安全且平順地進入門診血液透析治療。

This article is on nursing experience with a patient experiencing physical and psychological trauma after being diagnosed with end stage renal disease. Nursing intervention eventually persuaded the patient to accept hemodialysis. The period of care lasted from October 13, 2008 through to January 19, 2009. Data were collected through interviews, observations, chart views and telephone counseling with patient during his visits to outpatient services. The Gordon 11-item Function Health Pattern Assessment Method was also used to assess the health status of the patient. Four major health problems were identified including inadequate nutrition, hopelessness, disturbed sleeping patterns and decision making conflict. Personalized counseling was used to provide integrated and continuous nursing care. Inadequate nutrition was overcome by treating the patient's oral condition and making adjustments to cooking methods in order to improve his appetite; by actively caring about the patient, providing companionship, listening to the patient and informing him about the treatment method, his doubts and anxiety about the disease and its treatment were reduced. The support system was also used to improve the patient's self-confidence and help him face the future; the patient was taught relaxation techniques and acupuncture massage to improve his sleeping quality; the author also arranged for the patient to visit dialysis room so he could meet other patients and learn from their experience. The efforts successfully paved the way for the patient's smooth transition to outpatient hemodialysis services.