一位病人退休後接受血液透析治療之護理經驗

Nursing Experience for A Post-retirement Patient under Hemodialysis Treatment

本文探討一位病人退休後尚未依自己退休規劃生涯執行時，則需長期接受血液透析治療之護理經驗。筆者於2015 年9 月1 日至同年10 月17 日，藉由身體評估、觀察、直接照護、會談及整體性評估等技巧收集資料與個案建立互信關係，發現個案因接受透析治療後打亂所有規劃，讓個案厭惡暫時性雙腔導管的存在，導致插管處傷口有感染跡象；亦因透析治療後有些限制（飲食上），個案無法接受和改變，導致個案於透析過程有不適情形發生；而個案自尊心強烈不想讓別人知道自己的病況，則選擇逃避及退縮，不與外界（親友們）有任何接觸。歸納其主要護理問題為潛在危險性感染、不遵從、社交性隔離。在照護過程中，主動關懷個案並與個案建立良好的護病關係取得個案信任，運用智慧型手機及彩色圖卡讓個案觀看，使其能慢慢接受暫時性雙腔導管的存在，並能主動觀察插管處傷口狀況以免感染；讓個案明瞭透析不適之導因，再設計飲水量紀錄表並指導控制水份攝取的方法，讓個案有效的控制體重；運用爺孫間的互動關懷軟化個案強烈的自尊心，同時介紹類似案例的腎友，協助個案走出人群亦能主動與親友們聯繫；引導個案發現自我存在的價值感，並協助適應疾病，重新調整步伐重返家庭與社會，以期此案例之照護經驗，建議每位醫護人員對於病人心理層面的改變應具有敏捷的觀察力，發現問題後早期轉介，及時提供心理支持導正個案不正確的思維。

 

This study aims to explore the nursing care experience for a patient who began receiving long-term hemodialysis treatment before even having the chance to execute his intended extended retirement plan. From September 1 to October 17 of 2015, the author collected data and developed mutual trust with the patient through physical assessment, observation, direct care, interviews and overall evaluation. During which the author found that the patient disliked the double lumen catheter as the hemodialysis treatment interrupted his overall plan, resulting in wound infection in the cannula site. In addition, the restrictions imposed on the patient, especially in diet, due to the hemodialysis treatment made the patient annoyed and reluctant to accept change, giving rise to adjustment issues related to hemodialysis. To make matters worse, the patient chose to avoid contacts with others including his relatives and friends as he was reluctant to let others know about his illness out of pride. The main problems with nursing include the potential risk of infection, non-compliance and social isolation. In response, the author showed proactive caring for the patient and established a good relationship with the patient to build trust while eliminating the patient’s reluctance to the double lumen catheter by introducing the use of smart phones and colored flash cards to help the patient understand the process and learn to observe the wound at the cannula site to prevent infection. On the other hand, the author made efforts to explain to the patient the discomfort arising from hemodialysis and designed a water intake log sheet to maintain effective control of the patient’s water intake and weight. Furthermore, the author utilized interactions between grandson and grandfather to solve the problem of strong self-pride while introducing patients with similar diseases to help the patient in this case take the initiative to contact with his relatives and friends. All of the above efforts were made to guide the patient to find the value of self-existence and help him adapt to the disease so that he could embrace family and society again. In view of this nursing experience, it is recommendable that every health care worker should be more observant of patient’s psychological changes, early referrals after problems are discovered and psychological support should be provided in time to correct the situation.