一位長期血液透析患者食用楊桃汁自殺之急診護理經驗

本文敘述一位慢性腎衰竭患者因長期血液透析而企圖自殺之急診護理經驗，護理期間為2019年2月26日至2月27日。筆者運用觀察、會談、直接照護及護理衛教方式收集資料，並以Gordon十一項功能性健康評估為指引進行身體評估，確立個案主要健康問題為體液容積過量、無望感、照顧者角色緊張。於護理過程中，個案表示因面對每週血液透析造成身體不適，引發憂鬱的負向情緒，更須藉由藥物輔助才可入睡，導致個案利用禁忌食物楊桃汁想結束生命，但未能成功，使得病人須承受更多生理與心理上的不適、及家屬的擔憂與恐懼。筆者藉由主動關懷、同理心、支持、陪伴與鼓勵，引導個案及家屬抒發情緒，並與個案及案夫建立互相信任的人際關係，也運用醫療團隊力量及結合家庭支持系統，逐漸接受自己疾病的治療方式，期望藉此護理經驗分享，可提供日後急診室護理人員面對生理問題合併心理壓力病患之參考。

關鍵字

急性腎衰竭；無望感；照顧者角色緊張

並列摘要

This paper describes the emergency care experience on a patient with chronic kidney failure, who attempted suicide due to long-term hemodialysis,from February 26 to February 27, 2019. Data were collected through observations,interviews, direct care,and health education.Gordon's11 Functional Health Patterns were used to assess the patient's physical conditions.The primary health problems were established as follows:excessive body fluid,sense hopelessness, and caregiver role stress. During the nursing process, the author discovered that the patient faced weekly hemodialysis and the subsequent discomfort, which triggered depressive mood in the patient. The patient required sleeping pills to fall asleep. All of the above resulted in the patient's attempted suicide by dinking star fruit juice, a contraindicated food. This failed attempt caused more physical and psychological discomfort in the patient and incurred worries and fear in her family. The author guided the patient and her family to release their emotions through active concerns, empathy, support, company, and encouragement, forming a mutual trust with the patient and her husband. Through the support by the medical team and the patient's family, the patient gradually accepted the method for treating her disease. The care provision experience described in this paper is expected to provide a reference to other emergency care personnel in providing care to patients with combined physiological problems and psychological stress.

並列關鍵字

acute kidney failure ； sense of hopelessness ； caregiver role strain

參考文獻

李秀珠、陳秋惠(2016)‧照護一位類風溼性關節炎患者面對血液透析治療之護理經驗‧臺灣腎臟護理學會雜誌，15 (2)，83-95。[Shiow, J. L., & Chiu, H. C. (2016). The nursing experience from taking care of a rheumatoid arthritis patient undergoing hemodialysis. Journal of Taiwan Society of Renal Nursing, 15(2), 83-95.] https://doi.org/10.3966/172674042016061502007

林玉菜、林建志、鄭秀津(2016)‧照護一位急性腎衰竭個案之加護護理經驗‧領導護理，17(2)，70-79。[Yu, T. L., Chien, C. L., & Zheng, X. J. (2016). The Nursing experience of caring for an ICU patient with acute kidney failure. Leadership in Nursing, 17(2), 70-79.] https://doi.org/10.29494/LN.201606_17(2).0007

陳宜亞、方德昭(2012)‧透析患者之憂鬱症‧腎臟與透析，24 (4)，259-262。[Yi, Y. C., & De, Z. F (2012). Depression in dialysis patients. Kidney and Dialysis, 24(4), 259-262.] https://doi.org/10.6340/KD.2012(4).03

張友駿、顏妙芬(2016)‧解密楊桃：與腎臟的糾葛‧台灣家庭醫學雜誌，26(4)，228-234。[Yu, C. C., & Miao, fen. Y. (2016). The secret of star fruit and kidney. Taiwan Journal of Family Medicine, 26(4), 228-234.] https://doi.org/10.3966/168232812016122604005

梁婉萍(2014)‧慢性腎臟病靈性照護經驗分享‧彰化護理，21 (1)，60-61。[Wan, P. L. (2014). Experience sharing on spiritual care for chronic kidney disease. CHANGHUA NUREING, 21(1), 60-61.] https://doi.org/10.6647/CN.21.01.17

主題瀏覽