跨團隊模式照護初次建立血管通路的末期腎病病患之護理經驗

Nursing Experience of Adopting Interdisciplinary Team Model to Care End Stage Renal Disease (ESRD) Patient Facing First Establishment of Vascular Access

<>本文敘述一名末期腎病之中年男性在面臨需接受透析治療時，因無法適應內心之衝擊，而對其採取一系列生理、心理調適之護理經驗。於2019年10月01日至2019年12月31日護理期間，依Gordon十一項健康功能型態進行評估，運用會談、觀察、身體評估、病歷查閱及直接照護等方式收集資料，確立個案有體液容積過量、潛在危險性感染、知識缺失等健康問題。體液容積過量方面，利用個人專屬飲水容器與制約方式控制水份攝取，有效減少體內多餘水份，避免體液容積過量之併發症再度發生；針對潛在危險性感染提供導管傷口及瘻管傷口照護指導單張，並藉由回覆示教了解個案理解程度，提升導管傷口居家照護能力及技巧，以預防感染發生；知識缺失方面，利用網路教學影片協助教導，運用跨團隊模式，整合各專業相關醫護人員與病人配合，即時提供完整瘻管照護指導，提升正確認知，希望藉由此次護理經驗，做為日後護理同仁面對同疾病照護之參考，並運用在臨床照護中。<>

<>This article narrates the nursing experience of caring a middle aged man with end stage renal disease who is unable to sustain the psychological shock originated from the necessity of hemodialysis treatment, and serial following strategies composed of physical and psychological accommodation we adopt. Nursing care was provided from October 1 to December 31 of 2019, the evaluation was conducted based on Gordon’s 11 functional health patterns. Data collection was performed via interviews, clinical observation, physical examination, retrospective chart review/medical record review and primary care to evaluate the patient’s health problems such as excess fluid volume, risk for infection and deficient knowledge. For excess fluid volume, water restriction was conducted by using a personal water bottle and conditioning method, which can effectively reduce the excessive water in the body and avoid the recurrence of body fluid overload. In regard to risk for infection, we provided instructional leaflets about the wound care of catheter and fistula. Teach back method was done to learn patient’s insight and whether he could understand or not, it could improve the wound care ability and skills of vascular access at home and prevent the occurrence of infection. In terms of deficient knowledge, online teaching videos were used to assist teaching, interdisciplinary team model integrated relevant medical staff and patient. We provided complete fistula care guidance and improved patient’s correct cognition. To sum up above, we hope that this nursing experience will provide reference for future nursing in the care of the similar case and apply it in clinical care.<>