照顧一位重度聽、語障之長期血液透析患者的護理經驗

Nursing Experience of a Hemodialysis Patient with Severe Hearing and Language Impairment

本文敘述照顧一位接受長期血液透析之重度聽障及語障男士的護理經驗。患者因為水分控制不當而導致液體容積過量，引發透析時低血壓、抽筋等不適，並造成瘻管血流不足，無法達到足量透析，由於無法使用言語表達，因而產生溝通及學習上的障礙，造成生理、心理方面衝擊。護理期間自民國99年6月25日至99年8月4日，藉由直接照護、觀察、筆談及病歷查閱等技巧進行資料收集，運用Gordon十一項功能性健康評估，整理分析之護理問題為：體液容積過量、焦慮、知識不足等健康問題。照護期間採持續性、整體性護理模式，了解聽覺障礙者的身心特質，體諒他們因障礙所造成的不便與困難，互動全程利用與聽障者之溝通原則，針對其特質及問題提供獨特性的護理，例如筆者自行設計簡易的紀錄單張，教導個案評估餐飲型態；收集瘻管照護相關的圖片，隨時提醒個案自我照顧；學習簡單的手話，給予個案支持與鼓勵，增強學習及溝通意願，同時以陪伴、筆談等主動與個案建立良好護病關係，並與家屬溝通，健全個案的支持系統，使個案獲得良好的照護與調適。結案後仍對個案來院洗腎時追蹤半年，其仍能持續控制水分，達足量透析，獲得較滿意的生活品質。此次經驗從個案得到很多回饋，讓筆者深深感受到護理的成就與價值，希望藉此篇文章分享護理經驗，作為日後照顧此類患者之參考。

This article describes care experiences of a male long-term hemodialysis patient with severe hearing and language impairment. Obstacles encountered during hemodialysis included: hypotension, spastic discomfort and inadequate dialysis from insufficient A-V shunt flow. The problems were compounded as the patient's speaking and hearing functions were impaired, resulting in psychological and physical issues to the patient. Between 2010/06/25 and 2010/08/04, several major nursing problems were identified via direct care, observation, written conversation, medical chart inspection and the Gordon functional health patterns. The problems were body-fluid overload, anxiety and inadequate knowledge. To learn about the patient's physical and mental condition as well and sympathize with the inconvenience and difficulties caused by those obstacles, each was targeted and solved through interaction and continuous and systemic individualized nursing care. For example, simple recording charts were designed and provided to educate and assess patient's dietary habits; Pictures about A-V shunts were collected and shown as a reminder on the importance of A-V shunt self-care; basic sign-language was learned to provide positive support and reinforcement to the patient. The support system enhanced patient's motivation to learn and communicate. Positive nursing-patient relationship was also established through active companionship, writing conversation and family communication. A 6-month followed-up after the care period showed that the patient was able to maintain fluid control for adequate dialysis and achieve satisfactory life quality.