照護一位血液透析老人面臨遷移壓力之護理經驗

Nursing Experience of an Elderly Patient undergoing Hemodialysis Facing Relocation Stress

本文探討一位血液透析老人面臨遷移壓力之護理經驗。個案因年老雙膝關節退化乏力，在家跌倒兩次以致膝關節受損、無力且家人無法專任照顧下遷居至安養院。個案因未經同意下被送往，以致對家人感到失望產生許多負向思考及行為，筆者於2015年3月11日至4月27日，藉由每週三次來院執行血液透析治療時，採實際護病互動過程，耐心傾聽及深入會談的方式並且運用Gordon十一項健康功能型態評估等技巧收集資料，發現個案入住安養院後所產生的問題有不遵從、睡眠型態紊亂、無望感皆由遷移壓力所導致，以協助改善遷移壓力為主要護理問題。照護過程中，主動關懷個案並與個案建立良好的護病信任關係，運用家庭支持系統與家屬及安養院護理師共同擬訂照護計畫，鼓勵家屬時常到院陪伴、復健及可利用假日或連續假期，將個案接回家中小住；教導家屬使用智慧型手機，下載視訊軟體，與個案約定每日視訊時間，增進親子間互動、建立個案自我存在價值感、減少個案對陌生環境的不安及抗拒，改善個案因遷移壓力所產生憤怒、自我傷害、拒絕服藥及飲食控制並引導個案正向思考，激發日後對生活的信心，期望藉此經驗提供日後護理人員參考。

This study explores the nursing experience of an elderly patient undergoing hemodialysis facing relocation stress. Actual nursing-patient interaction was implemented when undergoing hemodialysis three times a week at the institution during the nursing period from March 11 to April 27, 2015. The information was gathered by listening to the patient attentively, and conducting in-depth conversation through the use other techniques such as Gordon’s 11 Function Health Patterns. The subject’s issues such as non-compliance, sleep pattern disturbance, and hopelessness after being admitted to the nursing home were caused by relocation stress. The main nursing issue was assistance on coping with relocation stress. A good nurse-patient trust relationship was established, a family support system and care plan were set up by family members, and nursing staff at the nursing home were utilized. Family members were encouraged to provide the subject with companionship and to be present at the rehabilitation process; in addition, the subject was brought home for short periods on weekends or consecutive holidays. To increase interaction with family members, build the patient’s self-esteem, reduce the patient’s anxiety and resistance to an unfamiliar environment in order to promote positive thinking and increase confidence in daily living in the future, family members were taught to download video call apps via smart phones and make video calls at scheduled time each day. The experience is provided here as a reference for other nursing staff in the future.