一位末期腎病變病人初次接受血液透析之護理經驗

Nursing Experience of a Patient with End Stage Renal Disease Receiving First-Time Hemodialysis

本文探討一位末期腎病變病人初次接受血液透析之護理經驗，於2019/05/27–06/16運用Gordon十一項健康功能型態評估，經由觀察、會談、身體評估及病歷查閱等方式蒐集資料，確立護理問題有體液容積過量、特定知識缺失、焦慮。藉由提供「禁食食物、少食食物」放大版圖卡，調整烹飪方式，使用固定容量的水壺，達到重建體液平衡之管理；利用多媒體影片及「彩色換藥步驟圖卡」，提升個案血液透析自我相關照護能力及增進透析管路照護技能；並以傾聽、鼓勵使其宣洩負向情緒，安排成功案例腎友的經驗分享，主動召開跨專業領域及家庭會議，協助個案減輕焦慮、適應日常生活型態之改變。經此照護過程，發現個案因未及早接觸腎臟透析資訊及準備，護理人員如何協助個案在第一時間接受醫師建議的透析治療是照護上的一大困難，而個案出院後僅以透析當日關懷及電話追蹤，無法完善的評估成效及適時調整照護，是筆者面臨的照護限制。經此照護經驗，建議落實早期轉介至腎臟照護團隊的機制，及長期照護計畫可深入社區實際家訪、持續追蹤，促進適應日後透析生活。盼藉此經驗可作為未來照護此類病人之參考。

This paper aims at exploring the nursing experience in a patient with end stage renal disease who received first-time hemodialysis. Gordon 11 Function Health Patterns were applied for evaluations from May 27, 2019 to June 16, 2019. Observations, interviews, physical assessments and medical history reviews were the measures taken for data collection. Several nursing problems, including excessive fluid volume, specific knowledge deficit and anxiety, were thus found and confirmed. The re-establishment and management of body fluid balance was achieved by providing cards with enlarged pictures of“food items forbidden or eaten less”, adjusting cooking methods and using a fixed-volume water kettle. Then, multi-media video clips and“color cards of dressing change steps”were presented to improve the patient’s self-care capability and nursing skills involved in vascular access for hemodialysis. In addition, we helped the patient to ease anxiety and adapt to daily lifestyle changes by listening to and encouraging the patient to express negative emotions, arranging other hemodialysis patients to share their successful experiences and actively convening cross-professional and family meetings. This nursing process enabled us to discover that the major difficulty for the nursing staff taking care of the patient was to help him accept the doctor’s treatment advice in a timely manner. Without access to information about kidney dialysis, the patient would not be prepared for hemodialysis in time. On the other hand, the nursing limitation encountered in this study was that comprehensive assessments on dialysis results and timely nursing adjustments could not be made merely through care given on the day of hemodialysis and upon followup calls after discharge from hospital. Based on the above nursing experience, it is suggested that a system for giving early referrals to kidney care teams should be put into practice and long-term care programs should facilitate in-depth family visits in communities and continuous tracking so as to help patients adapt to future life with hemodialysis. Hopefully, this experience can serve as a reference for nursing staff providing care for patients receiving hemodialysis in the future.