運用Orem理論照護一位接受腹膜透析併發腹膜炎患者之經驗

Application of Orem Self-Care theory to Peritoneal Dialysis Patient with Peritonitis Complication

文為探討照顧一位末期腎衰竭患者，在家行連續可活動性腹膜透析治療期間發生腹膜炎入院治療的護理經驗。筆者運用歐倫（Orem）自我照顧理論模式為臨床護理評估架構，於2011年3月7日至2011年3月21日以直接照護、觀察、會談及查閱病歷收集資料進行護理評估。發現個案有「體液容積過多」、「不遵從」、以及「焦慮」等護理問題。筆者針對護理問題擬定個別性護理計劃，並執行相關護理措施：教導個案如何改善體液容積過多的問題、澄清個案對腹膜透析治療錯誤的價值觀、了解腹膜炎相關治療及如何預防透析的感染，減輕個案焦慮程度，改善生理與心理的不適。個案出院後筆者以電訪、居家訪視及門診追蹤，協助個案發揮自我照顧能力，預防再度感染、減少不必要的醫療支出，並進而維持其生活品質。

The article explores the experience of caring for a peritoneal dialysis patient with peritonitis during hospitalized between March 7 to March 21, 2011. The Orem self-care theory was applied to guide clinical nursing evaluation. Patient was evaluated through direct care, behavioral observations, interview, chart views and past medical records. Problems such as ”body fluid overloading”, ”Noncompliance” and ”anxiety” were assessed. Based on these existing problems, the author developed and executed individual nursing plans and actions that included teaching the patient how to improve the condition of body fluid overloading, prevent infection related to PD, clarify misconceptions on PD therapy and improved understanding of treatment for peritonitis. These measures reduced the patient’s anxiety and helped reduce physical and psychological discomfort. After the patient was discharged from the hospital, the author monitored him by phone, home visit and clinical follow up, successfully enhancing his quality of life.