照顧一位慢性腎病之護理經驗

A Nursing Experience of Caring for Chronic Kidney Disease

本文描述一位年輕女性因罹患第一型糖尿病血糖控制不佳導致糖尿病腎病變而需終身洗腎之護理經驗，護理過程中觀察到個案除了需面對併發症的身體不適，心靈方面也承受相當大的壓力有待調適。因此，發現個案出現抉擇透析方式的困境及心理需加強面對洗腎的挑戰和信心，筆者了解該個案急需關懷和協助，故引發選案理由。護理期間於2018年2月24日至2018年3月19日，筆者運用Gordon十一項健康型態功能評估做為指引，透過會談、傾聽、觀察和身體評估收集資料，確立個案有身體心像紊亂、調適障礙及抉擇衝突等健康問題。護理過程中運用傾聽、鼓勵、支持使個案表達內心感受，提供多元化衛教管道，運用筆記表格與繪圖記錄，增加對透析的認識，並澄清錯誤觀念，更加入跨團隊由各專業領域給予透析衛教及個別化的護理措施，輔以醫病共享決策平台，了解個案想法，共同做出透析的選擇，陪伴其能以正面態度來面對透析治療帶來的衝擊，並於出院後經個案同意，舉辦「新腎友回娘家」活動，轉介腹膜透析小組，電話訪視持續追蹤，維持後續生活品質。期將此照護臨床經驗與護理同仁分享。

This article described the nursing experience of caring a young woman who suffered from diabetic nephropathy due to poor glycemic control in Type 1 diabetic mellitus and needed lifelong dialysis. During the nursing process, we observed that in addition to the physical discomfort, the patient also needed to adjust to the stress resulting from the disease. The patient faced the dilemma of which dialysis method to choose and needed help to strengthen her confidence in dialysis. During the care period from February 24, 2018 to March 19, 2018, the author used Gordon's Eleven Function Health Pattern Evaluation as a guide to collect information through interviews, listening, observation, and physical assessment. The mental disorders identified included body image disturbance, adjustment disorder, and decisional conflict. In the process of nursing, the author provided a health education using notes, forms, and drawing to clarity misconceptions toward dialysis. The cross-function team joined and provided individualized nursing care, giving the patient an optimistic perspective toward treatment. After being discharged, the patient agreed to participate the ''New Kidney Friends Back to Home'' event. With the intervention from the peritoneal dialysis team, we continued to follow up using telephone interviews to maintain her quality of life. We hope this experience can be shared with nursing colleagues who care similar patients.