協助一位青年接受初次血液透析壓力調適之護理經驗

The Nursing Experience of Assisting a Young Adult to Adapt to the Stress of Undergoing Initial Hemodialysis

本個案報告描述一位青年，接受初次血液透析治療時導致生理、心理、社會衝擊之護理經驗。筆者自2014年3月12日至4月30日，護理期間運用Gordon十一項健康功能評估，並藉由觀察、訪談、傾聽及身體評估等技巧收集資料。確立個案主要健康問題有：一、潛在危險性感染／與雙腔靜脈導管有關；二、知識缺失／與控制高血磷知識不足有關；三、焦慮／與面對血液透析所造成的壓力有關。照護期間運用主動關懷、傾聽技巧，依據文獻查證、提供血液透析相關知識，加強居家自我照顧能力，並採取導管組合式照護措施，預防感染情形發生；運用科技設備以手機照像功能取代手寫記錄，增加學習動機及便利性，達到病患自我控制高磷飲食行為，並加強家庭及社會支持系統的建立，使個案發展正向的人際互動和能力，提升自我價值，及對血液透析因應能力，目前個案能以正面的心態面對血液透析，並已重返社會職場，表示「有信心去面對往後的人生」。

This case study described the nursing experience of taking care of a young adult who suffered from physical, psychological, and social impacts when undergoing initial hemodialysis. From March 12, 2014 to April 30 of the same year, this study utilized Gordons 11 functional health patterns as the assessment method and collected data through observation, interviews, listening, and physical assessment skills. The patient’s major health concerns included: 1. potential risks for infection (related to double lumen catheters) 2. a lack of knowledge (related to not knowing enough about controlling hyperphosphatemia) 3. anxiety (related to the pressure of facing hemodialysis). During the care period of this study the author actively attended and listened to the patient’s needs. After gaining the patient’s trust, the author provided the patient with hemodialysis-related knowledge from research articles, utilized patient instructions produced by the department, improved patient’s selfcare ability, and used the catheterization care bundle to prevent infections. Technological equipment such as the camera on mobile phones was used to replace handwritten records. As a result, the patient became more motivated to learn and easier to take care of. The patient could self-monitor the dietary behaviors, thus be reminded to avoid the consumption of high phosphate food. The patient also consumed calcium regularly to control the phosphate level in the blood. This study was able to reinforce the establishment of family and social support systems and helped the patient to develop positive social interactions and skills. The patient’s self-worth was boosted and was able to adapt to the stress from hemodialysis while having good quality of life.