一位末期腎臟病人初次接受血液透析之護理經驗

Nursing Care Experiences of a Patient with End-stage Renal Disease Receiving the First Hemodialysis Treatment

本文旨在探討一位末期腎臟病患者初次接受血液透析之護理經驗，護理期間自2019年6月30日至7月20日，運用Gordon十一項健康功能型態為評估工具，藉由會談、觀察、身體評估及查閱病歷方式收集資料，確立個案主要護理問題為體液容積過量、急性疼痛及無望感，護理期間依照個案護理問題給予整體性的護理措施，經由限水、飲食衛教及血液透析治療，改善生理的不適，提供個案有關動靜脈瘻管照護衛教，以維持透析患者「第二生命線」的功能，並透過主動關懷、傾聽、同理心及信任感與個案建立良好的護病關係，鼓勵個案表達意見及內心想法，澄清個案對血液透析治療的疑慮，同理個案初次面臨透析之不安情緒，透過陪伴、家屬支持及腎臟病友經驗分享以減輕個案心理的焦慮及憂鬱，引導個案適當的表達情緒及想法，最後個案能以正向的態度面對血液透析治療，提升自我照顧能力，適應長期血液透析治療帶來的生活改變及能與疾病共存。建議職場上可設置工作人員交流的工作坊或定期的集會，彼此交換照護經驗，尤其是面對初次透析患者，能在第一時間提供最適切的護理措施。

The purpose of this article is to describe the nursing experience of assisting an initial hemodialysis patient with end-stage renal disease. The nursing period was from June 30 to July 20, 2019. Data was collected by observation, interview, physical examination, and chart review. Gordon’s 11 functional health patterns were applied for systemic evaluation. Three nursing problems were identified including excess fluid volume, acute pain, and hopelessness. The application of individual nursing intervention during the nursing process educated the patient and her family on water restriction, proper diets for kidney disease, and self-care of dialysis. Providing fistula care education to enhance the patient ability to care for the fistula and keep the ‵Second Lifeline′in working order. Using active caring, listening and empathy methods to build a trusting relationship and encourage the patient to express opinions and inner feelings, clarify and correct misinformation about hemodialysis, empathy the trepidation of the patient when facing initial hemodialysis, and through companionship, family support and sharing experience with dialysis patients to relieve the anxiety and depression. Guide the patient to properly express emotions and thoughts, and finally the patient was upgraded self-care ability and positive attitude to face long-term hemodialysis treatment, and live with illness. It is suggested to set up workshops or regular gatherings in the workplace to exchange nursing experiences with each other, especially for first-time dialysis patients, to provide the most appropriate nursing care at the first time.