跨團隊整合照護末期腎病個案心靈安適之經驗

The Experience of Interprofessional Collaborative Practice for End-stage Renal Disease Patient with Spiritual Wellness

陳怡穎(Yi-Yin Chen) ； 林帝芬(Ti-Fen Lin) ； 朱怡蓁(I-Chen Chu)

《志為護理-慈濟護理雜誌》 23卷1期 (2024/02) Pp. 106-117

摘要

本文為一位末期腎病個案因無法因應病程進展造成心靈困擾之照護經驗。於2021年1月24日至2月23日，運用生理、心理、靈性、社會四層面評估，透過直接護理、查閱病歷、會談收集資料，確立健康問題為呼吸道清除功能失效、皮膚完整性受損及心靈困擾。生理問題經口腔護理、胸腔物理治療照護、保持皮膚乾燥、選擇合適之傷口換藥方式等護理措施介入後，個案能有效排除痰液，壓力性損傷傷口亦無新增感染徵象；在心理問題方面，藉由跨團隊整合照護提供心理支持與靈性撫慰，並且引導個案進行醫療決策、參與生命末期討論、進行生命回顧建立自我價值，達成心靈安適目標。建議護理人員參與安寧療護及預立醫療照護諮商課程，提升臨床照護之敏銳度與溝通能力。

關鍵字

跨團隊整合照護 ； 末期腎病 ； 心靈安適

並列摘要

This article describes the care experience of a case of end stage renal disease in which the patient was unable to cope with the progression of the disease and caused spiritual distress. The nursing care period is from January 24 to February 23, 2021. Patient data was collected using physical, psychological, spiritual and social assessments, through direct care, medical records and interviews. The identified health issues were ineffective airway clearance, compromised skin integrity, and spiritual distress. Physiological problems were treated with nursing measures such as oral care, chest physiotherapy care, keeping the skin dry, and choosing an appropriate wound dressing method. The case effectively eliminated sputum, and there was no new sign of infection in the pressure injury wound. In terms of psychological problems, interprofessional collaborative practice provided psychological support and spiritual comfort, and guided the patient to participate in medical decisions and end-of-life discussions, conduct life reviews, build self-worth, and achieve the goal of spiritual wellness. Caregivers are encouraged to participate in courses on hospice care and advance care planning to enhance the sensitivity and communication skills of clinical care in this kind of case.

並列關鍵字

end stage renal disease ； interprofessional collaborative practice ； spiritual wellness

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