照護一位末期腎臟疾病病人初次接受血液透析的護理經驗

A Nursing Experience of Caring an End-Stage-Renal Disease Patient who Receiving Hemodialysis for the First Time

本文是描述一位因末期腎臟疾病初次接受血液透析個案的護理經驗。護理期間2015年1月22日至2015年3月5日藉由直接照護、會談、觀察、傾聽、身體評估及病歷查閱方式，以Gordon十一項功能性健康型態評估為指引，進行生理，心理，社會及心靈等層面，護理評估分析歸納個案主要護理問題依序為：潛在危險性感染，體液容積過量、無望感。照護過程中筆者藉由同理心及長時間主動關懷個案，建立信任的護病關係。教導透析導管照護之正確方法來預防感染，評估其飲食習慣，會診營養師提供個別性飲食指導，及限鹽限水的護理措施，藉由家人、教友良好互動與支持，與成功腎友的激勵，及聯繫院牧部牧者探訪個案，一同陪伴個案唱詩歌、讀經、禱告使個案從內心沮喪無助，轉變為在行為想法與態度上，有正向改變，促使個案體認生命的意義與價值創造希望，坦然面對治療及未來的生活。期望藉由此護理經驗，提供護理同仁在照護此類個案之參考。

This article describes the nursing experience of caring for an end stage renal disease patient receiving hemodialysis for the first time. In the duration of January 22, 2015 to March 5, 2015,the case was analyzed and evaluated in various aspects using Gordon's Eleven Functional Health Patterns, such as physiological, psychological, and social and spiritual. The patient received care via direct contact, communication, observations, listening, physical assessments and review of medical records. It was concluded that the patient had several problems, including potentially dangerous infections, fluid overload, and the feeling of hopelessness. The patient was under care for an extended period of time, and thus was able to establish a trusting relationship with care-givers. The patient was taught how to care for the dialysis catheter to prevent infections, and, after evaluating their eating habits, was given consultation with dieticians that provided them with an ideal salt and water intake. The patient developed a more positive attitude with support from family and friends from church, encouragement from other dialysis patients, and company from church pastors through singing poetry, Bible readings, and praying together. Through the process, the patient realized the meaning and value of life, and could accept the dialysis treatment and future life calmly. This nursing experience can provide nurses with an excellent example when facing similar cases in the future.