一位透析個案面臨腎移植抉擇之護理經驗

The Experience of Nursing a Dialysis Patient Considering a Kidney Transplant

本篇是描述一位腹膜透析失敗轉以血液透析的個案，在面對透析模式轉換過程中，對新的治療方式不瞭解，產生適應困難，因而興起換腎的念頭。然而國內器官捐贈數量甚少，促使個案欲到境外接受移植，因缺乏相關資訊及對境外醫療品質存疑，造成兩難的抉擇。護理期間自2012年4月10日至5月25日，藉由觀察、會談、身體評估及電話聯繫等方式收集資料，根據Gordon 11項進行評估，發現個案有血液透析治療合併症與自我照護知識不足、體液容積過量、無力感與抉擇衝突等問題，護理過程中陪同觀賞血液透析衛教光碟、實物示範與回覆示教，適時釐清疑問，讓個案認識血液透析，運用警示卡及食物圖卡的說明，達到限水目的。運用傾聽及同理心，給予關懷與支持，協助尋找移植網站及資訊；舉辦「新腎友回娘家」活動；轉介相關單位，協助個案獲得足夠訊息，選擇合適的替代療法，讓個案重拾自信心，回復正常社交生活，以提升生活品質。

This article describes a patient transferred to a hemodialysis unit after failure ofnperitoneal dialysis, and his problems in adapting due to his not knowing much about the new treatment modalities. The idea of receiving a kidney transplant arose; however, due to the scarcity of domestic organ donations, the patient planned to receive the kidney transplant abroad. Due to his lack of relevant information and doubts about the quality of medical care abroad, he faced a dilemma. The duration of care was from 10 April to 25 May, 2012. We collected data by observation, talks, physical assessment and telephone contact. According to Gordon’s 11 - item assessment, we found that this man had problems with insufficient knowledge about hemodialysis complications and self-care, fluid overload, feelings of powerlessness, and conflicted decision making. During the nursing process, we accompanied the patient in watching hemodialysis health education CDs. We also offered demonstration teaching, repeated what was demonstrated earlier, and ensured timely clarification of questions, as the patient became acquainted with hemodialysis. By the use of warning cards and food picture cards, we reached the goal of water restriction. We offered care and support by the use of listening and empathy, and assisted in finding websites about transplants and associated information. We organized the activities of 'Reunion for Friends with New Kidneys' and helped in getting enough information, so that the patient could choose proper renal replacement therapy. Thus the patient regained selfconfidence, returned to a normal social life, and his quality of life improved.