運用健康信念模式照護一位拒絕緊急血液透析的急診病人

A Nursing Experience of Applying the Health Belief Model to an Emergency Patient Who Refused Acute Hemodialysis

本文分享照護一位末期腎病變個案面臨緊急血液透析決策的急診護理經驗，護理期間為 2011年10月19日至2011年10月25日，以生理評估為架構，藉由直接照護、觀察與會談等方式收集資料，發現個案有體液容積過量、無效性健康維護能力之健康問題，醫護團隊首先穩定個案 的生命徵象、改善生理不適，再依據健康信念模式嘗試深入探索個案在意的健康問題，降低個案拒絕透析的行動障礙，增強其接受透析的行動利益，協助接受緊急血液透析治療，後續增加 疾病自覺嚴重性、提供行動線索，促進健康維護能力。此次照護經驗深切體會到健康信念的增強，可以幫助個案由慢性病中重生，因此成為選案與執筆分享之理由。

The purpose of this article is to describe a nursing experience with a case of end-stage renal disease where acute hemodialysis was refused. The nursing period spanned from October 19 to 25, 2011. On the basis of physical assessment and the Health Belief Model, the authors determined two major health problems as follows: excess bodily fluid volume, and ineffective health maintenance. Firstly, our medical and nursing team stabilized the patient’s vital signs and relieved physical discomfort. Then, using the Health Belief Model as an intervention, we explored the health problems the patient most cared about, overcame the mobility barriers to dialysis, enhanced the benefits of actions of dialysis, and assisted the patient in undergoing acute hemodialysis to save his life. Finally, we increased the patient’s knowledge of the perceived severity of disease, provided cues to actions, and improved health maintenance ability. The nursing experience showed that the enhancement of health beliefs could help patients be revived from chronic diseases.