運用悲傷輔導概念照護因喪偶而哀傷的高齡透析病患之護理經驗

Applying the Concept of Grief Counseling in Caring for an Elderly Dialysis Patient With Bereavement Due to the Death of Spouse: A Nursing Care Experience

本文是探討一位高齡76歲之透析患者喪夫之護理經驗，護理期間2015年4月2日至6月28日，藉由觀察、會談、查閱病歷報告及簡式健康評估量表等方式收集資料，以身體、情緒、社會、智能、靈性進行整體性評估。2015年三月個案出現食慾不佳、失眠、無望感以及哀傷，運用簡式健康評估量表評估個案有自殺的想法，確立健康問題有哀傷功能失常、無望感及睡眠型態混亂。主動關懷個案、傾聽、同理個案，並且運用Worden的「悲傷輔導原則」協助個案，完成哀悼的四項任務：（一）接受失落的事實；（二）處理悲傷的痛苦；（三）適應一個沒有逝者的世界；（四）在參與新生活中找到一個和逝者永恆的連結。透過整體及持續性護理措施與家屬溝通討論，一起協助個案，使個案重新適應生活，同時繼續接受血液透析，重新找到生活的新動力。 This article describes a 76-year-old dialysis patient who experienced widowhood. The nursing intervention occurred between April 2nd to June 28th, 2015. Using observation, interviews, medical records and health examinations, the authors assessed the patient's physical, psychological, social, intellectual, and spiritual status. The patient not only presented poor appetite, insomnia, hopelessness, and grief but had also attempted suicide. Thus, three health problems were identified, including dysfunctional grieving, hopelessness, and sleep pattern disturbance. Employing caring, active listening, and empathy, we helped the patient achieve the four tasks of Worden's Mourning: (1) to accept the reality of loss; (2) to work through the pain of grief; (3) to adjust to an environment in which the deceased is missing; and (4) to emotionally relocate the deceased and move on with life. With comprehensive and persistent nursing intervention, the patient got the support from her family members and eventually readapted to life without the deceased and continued to take hemodialysis and found new life motivation.