運用有效衛教策略照顧一位抗拒血液透析老人之護理經驗

Taking care of an old patient who rejected receiving hemodialysis with an effective health education strategy

陳美霞(Mei-Hsia Chen) ； 陳姿妃(Tzu-Fei Chen) ； 陳繪竹(Hui-Zhu Chen)

《安泰醫護雜誌》 25卷1期 (2019/06) Pp. 81-94

摘要

本文敘述一位76歲年老病人初次接受血液透析引發的壓力與衝擊之護理經驗。護理期間自2016年5月20至2016年7月7日，運用Gordon十一項健康功能評估為工具，確認個案有急性疼痛、焦慮、與特定知識缺失：缺乏正確透析飲食知識等健康問題。在照護過程中，透過正向的護病關係，提供舒適護理及配合藥物讓個案疼痛不適身軀得以緩解，以同理態度接受其不滿情緒，透過傾聽、陪伴並邀請家屬一同參與，協助以正向態度接受血液透析治療；也將年齡與理解能力列入考量，提供以圖片代替文字飲食衛教，讓飲食衛教達到事半功倍之效果，及透析專用電話隨時可以諮詢。藉此，將健康講座融入社區，減少返家後面臨的恐懼感，讓個案隨時可以諮詢達到雙向溝通及無縫接軌的醫療品質。

關鍵字

血液透析 ； 抗拒 ； 老年人

並列摘要

This article describes the nursing experience of a 76-year-old elderly patient dealing with the pressure and impact of receiving his initial hemodialysis. The nursing period was from May 20, 2016 to July 7, 2016. Using Gordon's 11 Functional Health Pattern assessments, the patient was confirmed as having nursing issues of acute pain, anxiety, and lacking the knowledge of dietary restrictions on dialysis. During the caring process, by the means of establishing a relationship with the patient, providing comfortable nursing, along with the using of medicine, the patient's physical pain and discomfort was relieved significantly. Also, through the acceptance of this patient's bad mood with empathy, combining with strategies of listening, accompanying, and inviting the patient's family members to participate in the treatment process, the patient finally was able to receive hemodialysis with a positive attitude. Moreover, the patient's age and understanding capability were also taken into consideration; pictures, instead of texts, were presented in nutrition education and it was very effective. In this way, we can combine health-care seminar with community to reduce the sense of fear this patient had to face after returning home, making him be able to receive consultation at any time and thus achieved a two-way communication and seamless nursing quality.

並列關鍵字

hemodialysis ； rejection ； the elderly