照護一位老人喪偶後初次血液透析出現自殺行為之護理經驗

本文旨在探討一位剛喪偶的老人，因腎功能惡化接受血液透析治療後出現自殺行為之護理經驗，護理期間自2018年8月22日至10月31日，藉由Gordon十一項健康功能型態為評估架構，運用觀察、傾聽、訪談、身體評估及查閱病歷方式收集資料，確立個案之主要健康狀態為體液容積過量、無效性因應能力及哀傷。護理期間教導飲食及水份控制技巧及正向因應策略，以及每週三次，一次約20-30分鐘，持續六週的哀傷輔導等措施。個案兩次透析間的水份控制從5.5下降至2.7公斤以內，憂鬱指數從29分降至16分、言行表現由沉默寡言到能感謝與分享，及重新發現生命的意義，在家庭成員的情感支持與陪伴下向逝者道別，以及血液透析路上有家人同行與關心，一起走出悲傷及共同經營透析新生活，藉此護理經驗提供未來護理同仁照護類似個案有所幫助。

關鍵字

血液透析；自殺；無效性因應能力；哀傷

並列摘要

The main purpose of this study was to investigate the nursing experience of caring for an elderly patient who was recently widowed and attempted to commit suicide after undergoing hemodialysis due to deteriorating renal function. The nursing period was from August 22 to October 31, 2018. This study employed Gordon's 11 Functional Health Patterns as the assessment framework and collected data using observations, listening, interviews, physical assessment and medical chart review. Notably, it confirmed that the patients' main health issues were excessive body fluid volume, ineffective response ability and grief. During the nursing period, the author instructed the patient in dietary and water intake control skills through positive response strategies. Moreover, the author also implemented grief counseling measures three times per week, 20-30 minutes per session for six consecutive weeks. The patient's body fluid volume for two dialysis sessions was reduced from 5.5kg to less than 2.7kg, and the depression index was reduced from 29 points to 16 points. In terms of communication and activity, the patient changed from being taciturn to sharing and expressing gratitude; in other words, the patient remarkably rediscovered the meaning of life. With the emotional support and companionship from family members, the patient was empowered to bid farewell to the deceased husband. The family members accompanied the patient and expressed their care in helping the patient face hemodialysis, walk out of grief, and walk towards a new life together. Hopefully, this nursing experience may serve as a reference to help other nursing personnel handle similar cases in the future.

並列關鍵字

Hemodialysis ； Suicide ； Ineffective response ability ； Grief (Sad)

參考文獻

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李秀珠、方梅珍、蔡曉薇、徐南麗(2016)．血液透析患者護理指導認知程度之探討．健康與建築雜誌，3(3)，43-51。https://doi.org/10.6299/JHA.2016.3.3.R4.43

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