一位初期接受血液透析有自殺行為個案之護理經驗

Experience of Caring for a Hemodialysis Beginner with Suicidal Behavior

吳佩珍(Pei-Chen Wu) ； 陳欣毓(Xin-Yu Chen) ； 吳麗敏(Li-Min Wu)

《臺灣腎臟護理學會雜誌》 16卷3期 (2017/09) Pp. 42-55

https://doi.org/10.3966/172674042017091603004

摘要

本文探討一位慢性腎衰竭個案初期接受血液透析治療，於治療期間因無望感出現自殺行為之護理經驗。筆者於2013年1月20日至3月16日護理期間，應用Gordon十一項功能性健康型態評估，藉由身體評估、會談、電訪、查閱病歷等方式收集資料，加以分析整理，確立個案有：（1）自我殘害；（2）體液容積過量；及（3）營養少於身體所需之健康問題。護理過程中，透過主動關懷、傾聽及接納內心的感受與想法，藉由家庭、社會支持及協助個案與腎友互相支持與意見交流，找到自我價值與自信，減少個案自殺的意念；擬定個別性護理計劃，教導控制水份攝取量、執行體重自我監測與記錄、飲食衛教及血液透析治療，改善透析期間體液容積過量問題；利用護理指導方式，同時會診營養師，提供營養諮詢與計劃，建立良好的飲食習慣，滿足個案之營養需求。個案對長期透析時能正向調適及面對疾病所帶來的衝擊，進而重建自信並找回對生命的信心與希望，恢復往日生活型態。

關鍵字

血液透析 ； 自殺 ； 體液容積過量 ； 營養少於身體所需

並列摘要

This article discusses and posts the experience of caring a chronic kidney disease patient, who after receiving initial hemodialysis therapy, presented suicidal behavior due to sense of hopelessness from the disease and treatment. During patient care period from 2013 January 20 to March 16, the author used Gordon's eleven functional health patterns assessment techniques to collect data, including physical assessment, interviews, medical records, etc., From analysis, it was determined that the case subject had below health problems: (1) Self-mutilation (2) excess of fluid volume and (3) nutrition less than body requirements. During caring process, apart from providing active care, the author also gave careful attention and accepted the patient’s internal feelings and thoughts. Through assistance from family members, social support and interaction with other dialysis patients the author helped him to regain self-worth and self-confidence, and diminished his suicidal thoughts. Furthermore, individualized caring program was developed that included education on how to manage daily fluid intake, the use of self-monitoring body weight assessment form, suggested diet plan for hemodialysis treatment, to help in controlling/diminishing fluid excess during dialysis. By providing appropriate caring guidance together with dietitian’s advice to meet the nutritional needs, the case subject was able to adjust positively towards hemodialysis treatment and face the impact of disease, eventually rebuild self-confidence, regain hope and resume to a healthy lifestyle.

並列關鍵字

hemodialysis ； suicide ； body fluid excess ； malnutrition

參考文獻

宋文英、鄒淑萍、蔡明足(2010) 照護一位不遵從血液透析醫囑病人之護理經驗.北市醫學雜誌， 7 (2) ， 177-183 ° doi: 10.6200/ TCMJ.2010.7.2.10

盧素眞、陳世宜、黃淑珍、蘇玲華 ( 2010) 血液透析病患睡眠障礙、憂鬱程度及其生活品質的分析探討,護理暨健康照護研究, 6 (1) » 33-43 ° doi: 10.6225/ JNHR.6.1.33

陳慧芬(2013) 血液透析病患之素食飲食原則與常見的營養問題,腎臟與透析,25(4) ， 320-324 ° doi: 10.6340/KD.2013.4.12

黃姿瑋、許禎娟(2012),運用認知行爲療法於一位憂鬱症合併自殺行爲個案之護理經驗,源遠護理,6(1) ， 75-83 doi: 10.6530/ΥΥΝ.20 12.6.(1)09

李和惠、黃鈺雯、林麗秋、林貴滿、林素戎、方妙君……蘇淑芳等(2013) 泌尿系統疾病病人之護理,於胡月娟總校閱,內外科護理學(四版,1-139 頁)台北市:華杏。