照護一位末期腎病病人之護理經驗

本文描述一位高齡94歲末期腎病之病人，因案子心疼病人不願其受苦，故拒絕透析治療接受安寧照護之護理經驗。照護期間自2020年10月10日至10月17日，運用Gordon十一項健康功能型態為評估架構，以身體評估、觀察、會談、病歷查閱等方式收集資料，確立病人健康問題依序為低效性呼吸型態、體液容積過量及預期性哀傷，護理過程以安寧照護概念，首先提供以病人為中心之全人醫療照護，緩解呼吸困難及水腫之護理措施，例如：採半坐臥姿勢減少水分回流，以利呼吸順暢，以及穴位按摩(人中穴及三陰交穴)舒緩腫脹不適等，使病人得以安詳善終，並協同醫師、安寧共照護理師、社工師及宗教師關懷家屬提供心理支持，藉由跨領域團隊醫療之四全照護：全人、全家、全程、全隊照顧，緩解案子面對重要親人即將死亡的預期性哀傷，引導案子完成四道人生：道謝、道愛、道歉及道別，使案子能無遺憾且正向面對至親死亡。建議護理人員皆須接受安寧緩和照護之專業訓練，並在面對病情進展快速且存活期短之病人皆應提早轉介安寧緩和醫療盡早啟動四全照護模式，提升臨終病人之照護品質並讓家屬提早做好心理準備以度過哀傷、避免遺憾，以達到善終的目標。

This report outlines the case of a 94-year-old patient diagnosed with end-stage renal disease, whose son opted against dialysis and chose hospice care to alleviate suffering. The nursing period spanned from October 10 to October 17, 2020, during which data collection occurred using the Gordon 11-functional health assessment, involving communication, physical assessment, and review of medical records. Key health issues identified included inefficient breathing patterns, excessive body fluid volume, and anticipatory grief. Nursing interventions were grounded in hospice care principles. Patient-centered holistic care was provided to alleviate dyspnea and edema, such as adopting a semi-sitting position to ease breathing and administering acupoint massage to reduce swelling and discomfort. Collaboration with physicians, hospice shared care nurses, social workers, and religious personnel enabled comprehensive psychological support for family members. This interdisciplinary approach, based on whole-person, whole-family, whole-process, and whole-team care, aimed to facilitate a peaceful natural death for the patient. Additionally, efforts were made to address the son's anticipatory grief, guiding him through acceptance using principles of gratitude, forgiveness, love, and grace. Ultimately, the son accepted his mother's passing without regrets. It is recommended that all nursing staff undergo professional training in hospice and palliative care. Early referral to hospice care for patients with rapid disease progression and limited survival time allows for implementation of the hospice and palliative care model, enhancing end- of- life patient care quality and preparing families for the grieving process, thereby achieving the goal of a dignified natural death.