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運用醫病共享決策於法布瑞氏症病人初次血液透析之護理經驗

Nursing Experience in the First Hemodialysis of Patients with Fabry's Disease Using Shared Decision Making

摘要


本文探討一位65歲因法布瑞氏症引起末期腎病變與相關因素,同時協助個案選擇合適透析模式及減緩焦慮之經驗。照護期間自2016年10月26日至2017年01月31日,運用Gordon十一項功能健型態評估作為護理評估工具,以照護、觀察、會談及身體評估等方式收集資料,發現個案有決策衝突、營養不均衡-少於身體需要及焦慮等健康問題。醫護團隊運用共享決策協助個案選擇適合透析治療;筆者主動陪伴關心、建立信任感,鼓勵表達問題及需求,以緩解個案焦慮;與營養師及個案討論設計「水果含鉀紅綠燈」、「蛋白質翻翻樂」進行飲食規劃,維持良好營養,協助透析病人飲食控制,同時有良好營養照護及生活品質,正向態度面對血液透析。

並列摘要


This paper presented author's experience with a 65 year old male with Fabry's disease in ESRD, and assisted to choice appropriate dialysis mode and relieve anxiety, utilizing the Gordon 11 Function Health Patterns as a nursing assessment tool to collect data by means of nursing care, observation and communication, interviews and physical assessment. There was conflicting results in decisions and altered nutrition, but less than body reguirements and anxiety. Health care team used the shared decision making to assist case selection for dialysis treatment. The author takes the initiative to care, build trust, encourage the expression of problems and needs to alleviate anxiety, discuss with the nutritionist for diet planning like fruit containing potassium as, traffic light design ("fruit potassium-containing red, green traffic lights") and "protein turning" for diet planning. This maintain good nutrition status, assist dialysis patient in diet control. At the same time, this maintain good nutrition care and quality of life, ultimately a positive attitude for hemodialysis treatment.

參考文獻


何雅芳、林秋菊(2019)‧應用共享決策於末期腎臟疾病病人腎臟替代療法的決策衝突‧護理雜誌,66(4),95-102。https://doi.org/10.6224/JN.201908_66(4).12
李瑋珠、林蕙瑛、胡美枝、周莉娜(2016)‧一位初次接受血液透患者面臨透析方式抉擇之照護經驗‧新臺北護理期刊,18(1),83-92。https://doi.org/10.6540/NTJN.2016.1.007
李麗華、黃琪峰、林承叡(2018)‧法布瑞氏症‧腎臟與透析,30(2),57-62。https://doi.org/10.6340/KD.201806_30 (2).0003
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岳芳如、顏妙芬(2014)‧應用健康信念模式照顧一位初次接受血液透析患者之護理經驗‧臺灣腎臟護理學會雜誌,13(3),57-68。https://doi.org/10.3966/172674042014091303005

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