協助一位末期腎臟疾病病人面臨透析治療抉擇之護理經驗

Nursing Experience with Assisting End-Stage Renal Disease Patient on Hemodialysis Decision

本文探討一位末期腎臟疾病病人，因疾病因素導致需長期接受透析治療，病人因對透析模式治療不瞭解所引發抉擇衝突之因應與調適過程，筆者於2010/12/22至2011/1/12照護期間，藉由觀察、會談法及直接照護等方式收集資料，並以Gordon十一項健康功能型態為評估工具，確立病人有潛在危險性感染、抉擇衝突及焦慮等健康問題。在潛在危險性感染方面，教導正確執行透析換液無菌技術及透過跨部門腹膜透析室護理師專責指導與提供單位設置之簡易「腹膜透析傷口照護出院用品包」供病人居家照護，並減低感染機率；在抉擇衝突方面，藉由帶領病人了解腹膜透析室環境、觀看腹膜透析換液執行過程影片及介紹腹膜透析成功案例與病人認識，使病人能接受腹膜透析的治療方式；另外，尊重並接受病人對長期透析的負向感受及情緒反應，同時耐心說明腹膜透析的換液過程、提供「腹膜透析衛教手冊」及單位製作之「腹膜透析換液居家簡易處理提示單」，配合腹膜透析換液技術示範與回覆示教及澄清病人疑慮，使其焦慮感降低，進而使病人可回歸正常生活型態，且提升返家後自我照顧能力。期望藉此護理經驗能提供護理人員日後照護此類病人的參考。

This report describes the experience with an end-stage renal disease patient requiring long-term peritoneal dialysis that experienced decisional conflict due to a misunderstanding over method of treatment. Through observation, conversation, direct care and Gordon's 11 functional health patterns, several health problem were identified: risk for infection, decisional conflict and anxiety. To deal with the risk for infection, the patient was taught how to correctly perform the CAPD fluid change aseptically. A basic ”CAPD Wound Home Care Kit” was also put together with the help of CAPD technicians for the patient to use for home care and reduce the risk of infection. With regards to decisional conflict, the patient was shown around the CAPD ward, watched the educational video on CAPD fluid exchange and introduced to successful CAPD cases. These measures helped the patient come to terms with CAPD treatment. Lastly, we respected and accepted the patient's negative and emotional reaction to long-term dialysis. We then patiently explained the CAPD fluid exchange process, provided the patient with the CAPD educational handouts, demonstrated CAPD fluid exchange technique and answered patient's concerns. By reducing the patient anxiety in these ways, the patient was able to resume a normal life and was better-equipped for home care. We hope the nursing experience will prove useful to nursing staff caring for similar patients in the future.