照顧一位愛滋受刑者合併血液透析的經驗

Nursing Experience with an AIDS Inmate Undergoing Hemodialysis

本篇描述一位37歲藥癮愛滋受刑者，因腎衰竭合併血液透析的護理經驗，筆者在2011年01月03日至2011年3月23日護理期間，透過會談、觀察、身體評估等方式收集資料，藉由Gordon十一項護理評估確立個案有「體液容積過量」、「知識缺失」、「情境性低自尊」等護理健康問題。體液容積方面筆者評估個案目前服刑中之個別性，指導個案體重監測及衛教飲食重點，進而改善體液容積造成的身體不適。知識缺失方面，評估個案現有的腎病飲食概念，並與個案及監所人員一起討論、計劃、評值，協助個案將腎病注意事項融入日常生活中，運用關懷、傾聽及同理心技巧，與個案建立良好的護病關係，提供照顧者愛滋病相關資訊，重視個案隱私，改善其情境性低自尊。個案出院後仍持續於本院進行血液透析治療，筆者得以持續關懷個案並協助其與愛滋病個案管理師及衛生所進行聯繫。本文提出以下建議：1.邀請監所人員參與院內腎友座談會及團體衛教，以提供受刑者較佳之健康照護。2.醫護人員至監所定期提供愛滋病及腎衰竭疾病照護相關課程。3.醫院安排護理人員相關專業課程及在職教育，以提昇護理人員擔任病人協調者及代言者的能力。

This article describes nursing care experience of a 37 year old male drug addict undergoing dialysis due to kidney failure. Through interviews, observations, and physical assessments between January 3rd and March 23th., 2011, the author and identified nursing problems such as ”fluid volume overload”, ”lack of knowledge” and ”situational low selfesteem”. To deal with the discomfort from fluid volume overload, the author assessed the patient’s situation, provided instructions relating to weight monitoring and diet control. The author assessed the client’s diet knowledge then discussed, planned and evaluated with clients and prison officers appropriate health activities for the client’s lifestyle. The author also applied listening and empathy skills, built up a good nurse-patient relationship, provided AIDS-related information, and respected the patient’s privacy during hemodialysis to make improvements to situational low self-esteem. The client has continued to receive dialysis treatment after discharge and the author continued to provide mental support and assistance to the client. The author contacted the AIDS division and local public health center to assist this client as well. This article makes the following recommendations: 1) Invite corrections officers to participate in the hospital’s kidney disease patient groups and health education classes in order to provide inmates with better health care; 2) Allow medical personnel to visit prisons on a regular basis to provide AIDS and kidney failure care-related courses 3) Have the hospital organize training courses and in-service education that help nurses play the role of patient coordinator and advocate.