運用Watson理論照護一位不遵從血液透析個案之護理經驗

Nursing Experience of Applying Watson’s Theory in the Care for a Patient Who was Noncompliant with Hemodialysis

本篇報告主要在探討照顧一位83歲末期腎衰竭個案不遵從透析治療之護理經驗，筆者於照護期間：104年2月4日至104年3月31日，運用Watson關懷照護功能性健康型態評估，採用傾聽、會談、實地觀察與照護等方式收集資料，確立問題加以分析整理，發現個案有體液容積過量、不遵從、無望感等護理問題。本個案聽信中藥療法治療腎衰竭，對血液透析治療內心充滿矛盾，因此出現未按時透析治療與水份控制不佳等不遵從行為，面臨疾病治療的無能為力，情緒憂愁、無望感隨之而來，故引發筆者撰寫此個案之動機，藉由Watson關懷照護因子為策略，主動關懷的技巧，同理心、接受與個案建立良好的護病關係，設計個別性的護理計畫，引導個案表達出內心感受，幫助個案飲食、水份控制及遵從透析治療，使個案能坦然面對疾病的發展，重新找回自我價值感，並建議單位增設老人族群專用「字體、圖片加大版」衛教單張區分使用，期望透過此護理經驗，提供護理人員對末期腎衰竭病患照護的參考，並期許在專業的領域上達到經驗分享，以便發展更有效的護理措施。

This report focuses on nursing experience of caring for an 83-year old patient with endstage renal failure who was noncompliant with hemodialysis treatment. The period of care ran from February 4 through to March 31, 2015. By applying Watson’s theory of human caring and functional health pattern assessment, data was collected through listening, conducting interviews, on-site observation, practical caring of the patient, etc., to discover, analyze, as well as compile the issues encountered. The patient was found to have nursing problems such as excess fluid retention, noncompliance, and hopelessness. The patient believed in traditional Chinese medicine for treating renal failure and did not have faith in hemodialysis, resulting in noncompliance behaviors such as non-attendance of regular hemodialysis sessions and inadequate control of fluid intake. The writing of this report was motivated by the patient’s depressive mood and hopelessness due to powerlessness in disease treatment. By adopting the care factors in Watson’s theory of human caring, as well as techniques of active caring, empathy, and acceptance to build a good nursing relationship with the patient, an individually-tailored nursing plan was formulated to help the patient express feelings, assist in food intake and fluid control, as well as to support the patient in attending hemodialysis sessions so that the patient can cope with the disease progression and regain self-esteem. The author would like to recommend the production of “health promotion brochures with larger texts and diagrams designed for the elderly” by the department. Through this nursing experience, the author also hopes to provide a reference to other nursing staff in caring for patients with end-stage renal failure. The sharing of professional experience will also hopefully lead to the development of more effective nursing strategies.