運用懷舊治療照護一位面臨遷移壓力之透析老人護理經驗

Experience of Nostalgic Therapy Given to An Aged Long-term Hemodialysis Patient Confronted with the Pressure of Migration

本文敘述一位長期血液透析老人因家人無法照顧，而被迫入住養護機構，面臨生活習慣與居住環境改變，對新環境產生適應困難，因而出現沮喪、情緒低落、無力、孤寂、懷疑自我價值等等負面情緒。護理期間自2013年6月17日至8月23日，以直接護理、觀察、會談及病歷查閱等方式收集資料，運用羅氏適應模式進行整體性評估，確立健康問題有體液容積過量、營養狀況改變、遷移壓力症候群等。護理過程中訂定機構與單位特殊交班單，以利無縫接軌之照護；與營養師共同設計客製化菜單，增加食物多變性與選擇性；運用食物模型示範攝食份量、水份提醒卡與水量杯使用，分別說明足夠蛋白質攝取量與水份控制的技巧；透析過程中主動陪伴、關懷，並引導說出心裡的擔憂，提供合宜的環境，讓個案適度表達不滿情緒與感受，藉由持續與個案、照護機構三向溝通協調，以家中日常用品營造熟悉的居住環境，利用舊照片與老歌音樂進行懷舊治療，減輕遷移新環境的壓力，引導探索生命之意義與價值，享受身、心安適之晚年生活。

This paper describes an aged long-term hemodialysis patient who had to move into a nursing center because his family could no longer take care of him at home. Faced with changes to his lifestyle and living environment, he had great difficulty in adapting to his new environment. Consequently, he developed negative emotions, such as sadness, depression, weakness, loneliness, and self-doubt, etc. The nursing care period started from June 17, 2013 to August 23, 2013. We collected information through direct nursing care, observation, interviews, and medical chart inspection, etc. We used the Roche adaptation mode to conduct an overall assessment, confirming that his health problems included excess body fluid, changes in nutritional status and migration stress syndrome, etc. During the nursing process, we formulated a special form for shift handover between the nursing center and the hemodialysis unit in order to facilitate the seamless integration of care. We also designed a customized menu with the nutritionists to increase food variety and selectivity. employing the food models to demonstrate the correct serving amounts for adequate protein intake. We also made water intake cue cards and used a water measuring cup to illustrate how to control water intake. During the dialysis session, we took the initiative to accompany the patient, demonstrated our concerns, and guided the patient to express his fears. We also provided an appropriate environment for the expression of his discontented emotions and feelings. With continued three-way communication and coordination, we helped to create a familiar living environment for him by using items he used daily from his previous home. We also used old photos and songs for nostalgia therapy so as to reduce the pressure of migration to his new environment and guide the patient to explore the meaning and value of life, helping him to be comfortable in body and mind in his later years.