協助一位單身女性正向面對初次透析治療之護理經驗

The Nursing Experience of Helping a Single Women Accept Initial Hemodialysis Treatment in a Positive Manner

本文旨在探討一位末期腎病變之單身女性，缺乏家人的感情支助，又面臨初次血液透析治療過程中，身、心的改變所引發護理問題。護理期間（2014年1月2日至3月15日）藉由會談、身體評估及查閱病歷收集資料等，依羅氏適應模式進行整體性評估，歸納出個案主要護理問題有：體液容積過量、焦慮、高血磷及無望感等。利用有刻度的容量容器，將每日所飲用水量，控制在一天700ml，解決病人體液容積過量；以「模擬手臂」，指導個案認識動靜脈瘻管之手臂，降低個案的焦慮感；並利用智慧型手機，將高磷飲食皆存放於相簿裡，協助個案換算平時飲食中食物的含磷量，進而減少高磷的食物，解決個案高血磷問題；給予個案正向鼓勵的支持口號，並介紹腎友臉書互動網，腎友臉書生活經驗分享，降低個案無望感讓其對未來有所計劃。建議單位可成立臉書腎友互動網，讓有腎友們有更好的互助詢問系統。臨床上針對類似個案，可以運用家庭系統或團體支持系統，讓個案減少焦慮及無望感。

This paper looks at the case of a single woman with health and mental problems related to end stage renal disease (ESRD) facing initial hemodialysis modality without adequate family support. During the nursing care period from January 2, 2014 to March 15, 2014, an overall assessment was conducted under the Roche adaptation mode to identify several key issues through talks, physical assessments, and examination of medical records. The main nursing care problems included: fluid overload, anxiety, hyperphosphatemia, and hopelessness. For fluid overload, we used a 700ml container to control the amount of drinking water each day. For relieving the patient’s anxiety, we designed “simulation arm” to let her know what a fistula looked like. To solve hyperphosphatemia, we saved photographs of high phosphate-containing food in the patient’s smart phone to help her identify and calculate the total amount of phosphorus in her daily diet. We gave the patient strength with supportive slogans and introduced her to a hemodialysis patient support group on Facebook for sharing everyone’s life and treatment experiences. The goal was to reduce patient’s sense of hopelessness and help her plan for the future. Every hemodialysis center should consider establishing their own support group or network on Facebook to help patients discuss or share their experiences and thoughts. For similar cases in a clinical setting, we can alleviate patient anxiety and hopelessness through their family or group support systems.