照護一位因嚴重合併症腹膜透析患者撤除透析之護理經驗

Hospice Nursing Experience of a Patient Withdrawing Dialysis due to Low Life Quality

本文探討一位48歲末期腎病患者因合併症導致生活品質低下，而選擇撤除透析接受安寧療護之照護經驗，照護期間為2020年4月20日至5月10日，運用整體性評估、觀察、會談及病歷查閱等方式收集資料，確立個案有體液容積過量、心靈困擾及死亡焦慮等健康問題。雖由病人意志明確下選擇安寧療護，但個案面臨死亡時仍有焦慮不安、徬徨無助等情緒，照護期間以協助減緩撤除透析後生理不適，並以關懷、同理，尊重個案意願協助參與安寧醫療決策，渡過低落及矛盾衝突之情緒，並透過安寧團隊跨領域之合作，及提供宗教信仰活動之靈性照護，達到心靈安適，最後與親友進行四道人生，討論往生事宜的準備，促成心之所想的善終。

 

This article described the nursing experience of a woman with low life quality withdrawing from dialysis. The author collected all the data through holistic assessment, observation, continued conversation and medical records from April 20, 2020 to May 10, 2022. We detected patient’s nursing problems, such as: excessive body fluid volume, psychological distress, and death anxiety. Although the patient clearly chose palliative care, she still felt anxious and helpless when facing death. The nursing process provided medicine and non-medicine method, to reduce the patient’s symptoms well controlled; giving care, empathy, and respect to her will, helping her participate in the palliative care decision-making and overcome depression and conflicting emotions, as well as providing nursing intervention through cross-disciplinary cooperation and religious activities to achieve her spiritual comfort. We encouraged the patient and families to express their love, thanks, apology, and farewell to each other, helping to arrange things before passing away to be good at dying and resolve the health problem of anticipatory grief and anxiety.