抗拒到接受～照護一位年輕女性狼瘡性腎炎之透析經驗

本文以一名25歲女性因狼瘡性腎炎行首次血液透析為例，護理期間自2020/1/10至1/21，運用Gordon十一項健康功能型態評估及深度訪談收集資料。資料歸納有一、潛在危險性感染、二、身體心像紊亂，三、無望感之健康問題，照護過程中主動關懷了解個案內心想法，透過個別性護理措施，提升個案對透析導管留置之照護知識與技能，討論外觀改變的影響，重新定義對美的概念及價值觀，並強化家庭、社會支持系統，使其理解透析治療對維持生命的重要性，並協助尋求自我生命價值，以達最佳的疾病角色調適及透析生活適應性。電訪中得知個案能維持一週兩次的透析治療，且近期完成腎臟移植登記，已能融入透析治療的新生活。期此護理經驗作為臨床護理人員照顧年輕透析族群之參考，幫助更多類此族群儘早適應疾病角色，進而提升未來生活品質。建議未來可建構腎友網路交流平台，在兼具隱私及安全的社交軟體中，透過網際網路與腎友經驗分享，為透析患者增加更為便利的交流管道，有效強化社會支持力量。

This paper presents a case study of a 25-year-old woman undergoing dialysis treatment for lupus nephritis, receiving nursing care from January 10th to January 21st, 2020. Data collection utilized Gordon's functional health patterns and in-depth interviews, revealing three primary health concerns: 1. Risk of infection; 2. Body image disturbance; and 3. Hopelessness. Employing empathy and active listening, the author provided tailored nursing care to assist the patient in managing catheters and initiated discussions to address body image perceptions. Efforts were made to bolster the patient's family and social support networks, aiding her in adapting to life on dialysis and finding meaning in life. A follow-up telephone interview indicated that the patient adhered to her dialysis schedule and was placed on the kidney transplant waitlist. This case study serves as a valuable reference for future healthcare practitioners. As a recommendation, it is suggested to establish a secure website or social media platform where patients can exchange ideas while maintaining privacy. This platform could serve to enhance social support networks among patients undergoing similar treatments.