運用Swanson關懷理論照護一位末期腎病病人無望感之護理經驗

Applying Swanson's Caring Theory to a Patient With End Renal Stage Disease Experiencing Hopelessness

本文為照護一位末期腎病行血液透析病人，長年受身體機能衰退、多次發生急慢性併發症所擾，對疾病失去控制感，失去生活目標，陷入低落、怨懟情緒而感到無望之護理經驗。照護期間為2019年8月23日至8月29日，以生理、心理、社會與靈性四層面評估確立了病人無望感的問題。筆者運用Swanson關懷理論的五大過程，於「了解」與「在旁陪伴」的過程，以主動關懷、傾聽，使個案展開心胸，表達對疾病的感受與情緒，以接納態度協助個案自我覺察對疾病的認知、失落以及負向想法；秉持「為他做某些事」及「使他能夠」的理念，衛教預防感染的知識、辨別體液過量的症狀及控制水份、鹽份的方法，提升病人疾病認知與自我照顧技巧，以降低發生急慢性併發症以及入院機會；在「維持信念」的過程，偕同家屬鼓勵與陪伴，並轉介病友團體強化支持系統，引導自我辨識與統整提升正面思考、自我價值，以接納自我的態度與疾病共存。建議護理人員運用關懷理論，以個案的角度與經驗感受為出發點，提供個別性照護計畫，賦能個案對疾病的認知、自我照顧技巧與強化支持系統，帶領病人覺察自我價值，重拾信心，增強病人對疾病的適應與提升照護品質。

This article describes an experience providing nursing care to a patient under hemodialysis with the end-stage renal disease who had developed depression, loathing, and other, negative personal perceptions and gradually gave up on life goals due to hopelessness. The duration of nursing care, from August 23rd through August 29th, 2019, was revisited to identify the patient's hopelessness in the dimensions of physiology, mental status, society, and spirituality. The author applied Swanson's Caring Theory to facilitate the process of ''knowing'' and ''being with'' while performing direct nursing care and attentive listening to assist the patient to become more open-minded and to express personal perceptions toward the disease with the goal of further engaging the patient to increase self-awareness recognition, sense of loss, and negative perceptions. Through ''doing for'' and ''enabling,'' the author reinforced infection control and identified the symptoms of fluid-overload, moisture, and salinity to raise the patient's self-awareness and self-caring techniques and to lower the risk of hospitalization. Meanwhile, by ''maintaining the patient's belief,'' accompanied by the encouragement and attention from family members and providing linkages to patient-support communities, the patient was guided to identify and aggregate to foster positive thinking and self-worth to increase acceptance of living with the disease. Nursing personnel may apply Swanson's Caring Theory to better consider the patient's perspective, provide individual caring schemes, and strengthen the recognition, self-caring techniques and supportive systems of patients, increasing patient perceptions of self-worth, restoring their confidence, promoting their adaption to their disease, and improving attentiveness.