運用整體力量模式協助一位無力感之腎衰竭病患接受透析治療之護理經驗

The Nursing Experience of Using a Holistic Power Model on a Chronic Renal Failure Case With Patient-perceived Powerlessness for Receiving Hemodialysis

末期腎病因腎臟不能排除體內多餘水分及廢物，造成水分滯留產生電解質不平衡，對身體除了造成代謝性酸中毒外，亦會誘發抽搐發作、血壓過高、水腫等症狀，必須接受透析治療挽救生命。本文描述一位46歲男性個案，因慢性腎衰竭末期須接受透析治療。起初在治療過程中個案因知識缺失造成接受透析治療的動機減少，又因疾病無法控制，進而造成無力感。筆者自 103年3月25日至4月23日，藉由觀察、會談、身體檢查及參與照護個案的過程，運用整體力量模式(Holistic Power Model, HPM)為架構，協助個案正視本身無力感，並藉由共享決策讓個案與母親參與透析決策並對於日後生活給予協助，期望提升個案生活品質。筆者亦期許本文能對 護理人員日後照顧此類病患提供照護經驗參考。

Kidneys are unable to remove fluid and waste products when chronic kidney failure develops to the end stage. End Stage Renal Disease (ESRD) not only causes water retention and electrolyte imbalance, but also induces seizure attacks, high blood pressure, and edema. Patients with ESRD must undergo dialysis treatment to sustain life. This article describes the nursing experience with a forty-six-year-old male patient who receives dialysis treatment. At the beginning, the patient declined the dialysis treatment due to the lack of knowledge and the feeling of powerlessness caused by losing control of the disease. Observation, interviews, physical examination and the Holistic Power Model were used to collect data from March 25 to April 23, 2014. The author encouraged the patient to face the problems and provided a Shared Decision-Making strategy to assist the patient to be involved in making decisions concerning dialysis. It is expected that such a successful nursing experience can be shared with other health care providers caring for ESRD patients who encounter powerlessness.