照顧一位首次血液透析病人心理調適過程之護理經驗

Nursing Experience of a First Time in Hemodialysis Patients Psychological on Adjustment Process

本文是探討一位首次接受血液透析病人，藉由觀察、會談、直接照護及身體評估進行資料收集，以生理、心理、社會、靈性進行護理評估，確立病人有「體液容積過多」、「疾病因應失調」、「自我照顧缺失」等三個護理問題。2010年07月29日～2010年08月22日住院期間（包含出院後電話訪問），不僅提供病人一般的生理照護外，會談傾聽病人及家屬的需求，提供血液透析衛教單張，及相關飲食、生活衛教、腎友經驗分享、協助血液透析院所選擇，將家屬及照護團隊納入護理計畫中，減輕病人對血液透析的焦慮及害怕，改變對血液透析的傳統偏差觀念，提升病人自我照護能力，其出院電訪中道出恢復原生照顧能力，以及對血液透析的改觀及如何相平衡。對初次血液透析病人而言，在疾病帶來的衝擊，除了需要家人關心及支持外，也需要透過醫護人員治療與照護，協助重新建立與慢性病共生的生活，期望透過本文能提供未來臨床護理人員照護此類病人時，除了提供一般的生理照護外，也能深入了解病人心理的問題，提供適時且個別的照護，提升未來臨床照護品質。

This article looks at a first-time hemodialysis patient. The author assessed the patient’s physical, psychological, social, and spiritual condition through observation, interviews, nursing care and physical assessment. The client had three nursing problem: ＂fluid overload＂, ＂inability to cope with the disease ＂and＂ ＂poor self-care.＂ Between July 29, 2010 and August 22, 2010, the author provided not only physical care during hospitalization and after the patient's discharge (including telephone interviews), but also listened to the needs of the patient and family members, provided information sheets on hemodialysis, set up experience sharing on diet, lifestyle, health education and other dialysis patients, included family members and the nursing team in the nursing plan, reduced the patient’s fear and anxiety with hemodialysis, corrected traditional misconceptions about hemodialysis and taught about finding balance. For a first-time hemodialysis patients, the impact of the disease required not only the family's support but the treatment and care of nursing workers to help the patient adapt to their chronic disease. This article will hopefully improve nursing care quality for hemodialysis patient so that in the future, in addition to provide physical care, more understanding can be shown for the patient's psychological problems. The provision of personalized care at appropriate times will enhance the quality of clinical care in the future.