照護一位老年血液透析患者導管傷口感染之護理經驗

Nursing Experience of a Catheter Wound Infection in an Elderly Hemodialysis Patient

本文描述一位老年患者接受血液透析治療，因不清楚導管照護方式導致感染，面對透析產生的衝擊和無效性的導管照護問題出現失落、無望等負面情緒。護理期間為2018年12月17日至12月22日，藉由觀察、會談、傾聽、病歷查閱等方式收集資料，並運用Gordon十一項功能性健康型態進行評估及分析，確立護理問題有組織完整性受損、知識缺失及無望感。照護期間藉由主動關懷及傾聽建立良好的護病關係，鼓勵家屬共同參與照護計畫，提供照片和製作導管照護影片，使個案傷口狀況日漸獲得改善，個案及家屬亦能了解導管照護的重要性；此外，當面臨問題而感到無助、無望時，透過家屬及腎友的分享、鼓勵表達內心感受、尊重個案的想法並了解其需求，提供心理支持，使個案能以正向的態度坦然面對返家後居家照護生活，達到並維持良好健康狀態。

This case report presents the nursing experience of an elderly hemodialysis patient who encountered catheter-related infections due to unclear catheter care. Confronting the challenges of dialysis and ineffective catheter care, the patient experienced feelings of loss, hopelessness, and other negative emotions. The nursing care period encompassed December 17 to December 22, 2018. Data collection involved observation, interviews, listening, and reviewing medical records, utilizing Gordon's 11-items functional health pattern to comprehensively assess the patient's health problems. Analysis revealed three nursing issues: impaired tissue integrity, knowledge deficit, and hopelessness. During the care period, the author established a strong nurse-patient relationship by actively listening to the patient's concerns. Encouragement was extended to family members, urging their active participation in the care plan. Visual aids, such as photos and videos, were provided to educate the patient and family members about proper catheter care, leading to a heightened understanding of its importance. Additionally, during times of distress and feelings of helplessness, the patient was encouraged to share his emotions with family members and other dialysis patients. The patient's thoughts were respected, and his needs were carefully understood and met, offering essential psychological support. As a result of this holistic approach, the patient developed a positive attitude towards home care, ultimately achieving and maintaining good health status after returning home.