運用醫病共享決策於法布瑞氏症病人初次血液透析之護理經驗

Nursing Experience in the First Hemodialysis of Patients with Fabry's Disease Using Shared Decision Making

本文探討一位65 歲因法布瑞氏症引起末期腎病變與相關因素，同時協助個案選 擇合適透析模式及減緩焦慮之經驗。照護期間自2016 年10 月26 日至2017 年01 月31 日，運用Gordon 十一項功能健型態評估作為護理評估工具，以照護、觀察、 會談及身體評估等方式收集資料，發現個案有決策衝突、營養不均衡-少於身體需要及 焦慮等健康問題。醫護團隊運用共享決策協助個案選擇適合透析治療；筆者主動陪伴 關心、建立信任感，鼓勵表達問題及需求，以緩解個案焦慮；與營養師及個案討論設 計「水果含鉀紅綠燈」、「蛋白質翻翻樂」進行飲食規劃，維持良好營養，協助透析 病人飲食控制，同時有良好營養照護及生活品質，正向態度面對血液透析。

 

This paper presented author’s experience with a 65 year old male with Fabry’s disease in ESRD, and assisted to choice appropriate dialysis mode and relieve anxiety, utilizing the Gordon 11 Function Health Patterns as a nursing assessment tool to collect data by means of nursing care, observation and communication, interviews and physical assessment. There was conflicting results in decisions and altered nutrition, but less than body reguirements and anxiety. Health care team used the shared decision making to assist case selection for dialysis treatment. The author takes the initiative to care, build trust, encourage the expression of problems and needs to alleviate anxiety, discuss with the nutritionist for diet planning like fruit containing potassium as, traffic light design (“fruit potassium-containing red, green traffic lights”) and “protein turning” for diet planning. This maintain good nutrition status, assist dialysis patient in diet control. At the same time, this maintain good nutrition care and quality of life, ultimately a positive attitude for hemodialysis treatment.