照顧一位接受活體腎臟移植身心調適之護理經驗

The experience of nursing care for a patient undergoing physical and psychological adaptations after a kidney transplantation from a living donor

本文探討一位42歲男性因糖尿病病程所致腎臟病變，先行血液透析治療，後續因生活品質受影響，故於器官捐贈移植登錄中心填寫移植意願但未獲屍體捐贈通知，經個案、家屬及腎臟科醫師三方討論後，決策擬採活體腎臟移植，接受治療期間身心調適歷程。照護期間於2021年12月03日至12月13日，以Gordon十一項健康功能型態工具、會談及身體評估等蒐集資料，確立健康問題有：急性疼痛、焦慮及潛在危險性感染等。針對急性疼痛，教導個案放鬆技巧，如：舒適擺位並合併止痛藥物介入，達到緩解不適；焦慮部分，提供個別性減緩措施，並以治療性會談技巧，引導個案闡述自身對案兄的罪惡感及擔憂，並啟動跨領域團隊合作精神，與移植協調師一同予個案即時性的健康資訊，包含：捐贈者之術後復原情形及返家後生理照顧方式，建構良好自我管理能力；潛在危險性感染著重傷口照護、識別感染徵兆及如何減少暴露於風險外，並結合跨團隊中的營養師予以換腎術後之營養攝取資訊。最終強化個案身心調適，使有自信地以正向態度開始新生活，希冀藉此經驗分享在照護類似個案時，能提供更適切的護理照顧，提升活體腎臟移植整體照護品質。

This article explores the physical and psychological adaptation of a 42-year-old male patient with progressive diabetic nephropathy who transitioned from hemodialysis to a live kidney transplantation. Nursing care was provided from December 3 to December 13, 2021, utilizing Gordon's 11 Functional Health Patterns, clinical interviews, and physical examinations to identify key nursing diagnoses, including acute pain, anxiety, and risk for infection. To manage postoperative pain, nursing interventions combined pharmacological analgesia with strategic positioning and relaxation techniques. Anxiety and emotional distress—specifically the patient's guilt regarding his older brother’s role as a donor—were addressed through therapeutic communication, emotional catharsis, and coordination with a transplant specialist to provide updates on the donor's recovery. Furthermore, an inter-professional approach was adopted to mitigate infection risks, involving a dietitian for nutritional optimization and providing the patient with comprehensive education on wound care and early symptom detection. Ultimately, this holistic nursing process facilitated both physical recovery and a positive psychological outlook, serving as a potential clinical model for enhancing comprehensive care in kidney transplantation patients.