慢性腎臟疾病病人之自我管理

Self-Management in Patients With Chronic Kidney Disease

慢性腎臟病（chronic kidney disease, CKD）為持續惡化的疾病，衍生的照護問題有其特殊性，需要從多方面來進行自我健康管理，才能與疾病共存。此疾病照護的複雜性與CKD的分期息息相關，根據腎絲球過濾率值（glomerular filtrationrate, GRF）下降程度，略分為五期，無論期別為何，病人日常生活與自我照顧都需要一定程度的改變。促進自我管理的重點為，病人與醫療照護提供者之間的合作與夥伴關係，所面對的課題包括：病人的評估與溝通、促進病人治療依從性、情緒管理、照護目標的協商、建立自我效能、進一步促使病人行為改善、正確描述及呈報症狀和使用適當的資源。護理師的角色在於針對不同階段腎疾病分期之病人，予以提供適當的醫療資源與衛生教育，以發展個案自我健康管理計畫及評值，協助病人身、心、靈達到良好調適，使病人能與疾病共存、延緩疾病惡化程度與提升生活品質。

Chronic kidney disease (CKD) patients typically self-manage their disease-care program. Self-management requires the investment of considerable time and energy in health management and in following the multifaceted CKD treatment regimen. CKD, a progressive disease, is classified into five stages that correspond to the five stages of decline in kidney function, as measured using the glomerular filtration rate (GRF). Each of these stages requires that a patient modify his / her lifestyle and shoulder the responsibility for day-to-day health management tasks. Key to promoting self-management is the partnership and collaboration between healthcare providers and patients. Tasks in this partnership include patient assessment and communication, regimen adherence, emotional management, negotiation of care plans, and the enhancement of self-efficacy, with the aims of creating positive changes in behavior, promoting correct symptoms interpretation and reporting, and promoting the appropriate use of resources. Nurses may help patients maneuver this initially frightening and sometimes difficult terrain with strategies that are tailored to each CKD stage.