協助協助一位半身癱瘓病人接受血液透析之護理經驗

Nursing Care of a Paraplegia Patient Receiving Hemodialysis

本文為探討一位下半身癱瘓病人初次接受血液透析治療，造成生、心理衝擊之護理經驗。照護期間自2011年11月16日至2012年1月2日，透過觀察、身評、照護與會談等收集資料，確立個案有：特定知識缺失、社交隔離、無望感之護理問題。於護理過程中運用「賦權概念」之手法，與個案建立信任感，引導個案思考腎衰竭後須面臨適應透析治療與生活等無法改變的事實，傾聽了解需求，透過共同討論與尊重其決定參與照護計畫，強化自我照顧的動機和能力以增進透析生活的自主權、掌控權，而減少無望感的產生。此外，筆者也介紹透析良好腎友為其支持系統的一部份，重新建立希望找到生命價值，並協助適應疾病，調整腳步再出發重返家庭及社會。期望藉此經驗分享，作為同仁日後照護之參考。

This study describes the nursing experience of a paraplegia patient with hemodialysis experiencing related psychosocial problems from November 16, 2011 to January 2, 2012 during nursing care. Observation, physical assessment and interview identified the following problems: knowledge deficiency, social isolation, and hopelessness. The author applied the concept of empowerment during nursing process to establish a therapeutic relationship based on mutual trust with the patient, convinced him to come to terms with dialysis after renal failure, and listened to the needs of the patient. The author also respected the patient’s decision to participate in his program of care with the expectation that this will enhance the patient’s decision-making power, strengthen motivation and ability for self care, and decrease the feeling of hopelessness. At the same time, the author introduced other patients undergoing successful dialysis treatment to help the patient form a support network, rediscover the value of life and assist the patient with adapting to the disease so he can return to his family and community as soon as possible. This report will hopefully provide useful information for the clinical nursing care of paraplegia hemodialysis patients.