自立支援導入慢性血液透析個案居家照顧之可行性探討

A Feasibility Study on Introducing Home Care for Chronic Hemodialysis Cases with Self-reliance Support

2018年臺灣透析人口為每百萬523人。腎衰竭個案因血液透析需限水但無法自我控制、衰弱、擔心瘻管阻塞…等，產生慢性病纏身的醫療與不便、無助與絕望，家屬同樣在血液透析的壓力中生活。依據自立支援照顧模式可以改善個案日常生活功能，提升日常自我照顧能力，而達到自主生活品質，那麼血液透析個案導入自立支援照顧模式是否能改善以上問題。本論文採質性研究，訪談彰化縣某血液透析中心3位個案，預期了解其自我照顧的問題，及自我照顧的方法；並了解透過編製之照顧手冊實施居家自立支援訓練指導後，對其體能之影響與感受，並提供日後照顧的建議。研究發現：慢性腎衰竭的血液透析個案有透析後疲憊、下肢腳無力、透析當日需要家人陪伴及水份控制的問題，雖然個案和家屬很想改變，希望過正常的生活卻是無計可施；在訪談中，個案可表述自覺運動很簡單又便利，而且運動後廔管流速較順暢，有達到運動後流汗的效果，有縮短精神萎靡的時間，體能及精神恢復且可聊天看電視；在飲食部份自覺可以吃得更快樂又健康。證實藉由自立支援導入慢性血液透析個案居家照顧之可行性，透過自我照顧及家屬支持，進而減輕焦慮及壓力。本研究成果預期應有實務應用價值，建議可以擴大推廣和研究。

The dialysis population in Taiwan in 2018 was 523 per million. Renal failure cases require water restriction due to hemodialysis but cannot control themselves, become weak, worry about fistula blockage, etc., resulting in chronic disease-ridden medical treatment and inconvenience, helplessness and despair, and family members also live under the pressure of hemodialysis. According to the self-reliance support care model can improve the daily life function of the case, enhance the daily self-care ability, and achieve the independent quality of life, then whether the introduction of the self-reliance support care model for hemodialysis cases can improve the above problems. This paper is a qualitative research, interviewing 3 cases of a hemodialysis center in Changhua County, expecting to understand their self-care problems and ways to improve self-care; The impact and feelings of physical fitness, and provide suggestions for future care. The study found that hemodialysis patients with chronic renal failure have problems of fatigue after dialysis, weakness of lower limbs and feet, needing family members to accompany and control water on the day of dialysis. The case can express that consciously exercising is simple and convenient, and the flow rate of the ducts after exercise is relatively smooth, which can achieve the effect of sweating after exercise, shorten the time of sluggishness, recover physically and mentally, and can chat and watch TV; Eat happier and healthier. The feasibility of introducing home care for chronic hemodialysis cases through self-reliance support is confirmed, and anxiety and stress can be reduced through self-care and family support. The results of this research are expected to have practical application value, and it is suggested that promotion and research can be expanded.