運用Swanson關懷理論照護一位腹膜透析愛滋病人轉血液透析之照護經驗

Care Experience of Applying Swanson’s Caring Theory: A Case Study of an AIDS Patient Switching from Peritoneal Dialysis to Hemodialysis

本文是運用Swanson關懷理論照護一位腹膜透析愛滋病人轉血液透析之照護經驗。護理期間為2021/11/25-2022/02/17，筆者運用生理、心理、社會及靈性四大層面進行評估，以會談、觀察、身體評估、病歷查閱及醫療團隊討論等方式收集資料，確認健康問題有體液容積過量、潛在危險性損傷、焦慮及知識缺失等。護理過程運用Swanson關懷理論為基礎，建立治療性及信任的護病關係、鼓勵個案表達內心焦慮的感受。依據個案本身的理解能力提供血液透析相關治療計畫及針對血管通路、透析合併症、飲食照護等疑慮，設計擬定客製化衛教內容，以提升自我健康識能；並透過智慧型手機連接健身手環自我管理APP，監測每日體重、血壓及心跳變化，可有效讓個案控制體重及水份的攝取，同時以尊重、接納真誠的態度，讓個案能正向且接受血液透析的生活，最終達到身心及健康安適狀態，期望藉此護理經驗能提供臨床人員照護類似病人之參考，進而提升臨床透析照護品質。

This study describes our experience applying Swanson’s caring theory to an AIDS patient who switched from peritoneal dialysis to hemodialysis. The nursing period was from November 25, 2021, to February 17, 2022. Assessment was conducted across four dimensions (i.e., physical, psychological, social, and spiritual), and data were collected through interviews, observations, physical assessments, medical record reviews, and medical team discussions. The health problems identified included hypervolemia, potentially dangerous injuries, anxiety, and a lack of knowledge. The nursing process was based on Swanson’s caring theory, which enabled the establishment of a therapeutic and trusting nurse-patient relationship and encouraged the patient to express their feelings of anxiety. A hemodialysis-related treatment plan was provided based on the patient’s comprehension ability, and health education content was customized to address the patient’s concerns, including vascular access, dialysis complications, and dietary management, to enhance the patient’s self-health awareness. A fitness tracker linked to a self-management app via smartphone was also used to monitor daily changes in the patient’s weight, blood pressure, and heart rate, which effectively enabled the patient to control their weight and water intake. In addition, a sincere attitude of respect and acceptance was adopted, which helped the patient accept a life on hemodialysis with positivity, ultimately achieving a healthy and comfortable physical and mental state. We hope that our nursing experience can serve as a reference for clinical staff when caring for similar patients, thereby improving the quality of dialysis care in clinical practice.