- 期刊
一位初次血液透析病人心理調適之護理經驗
Nursing Care for the Uremic Patient Receiving First Hemodialysis
摘要
本文旨在探討一位末期腎病變併肺水腫出現呼吸窘迫，被知會需靠血液透析維持生命，因受母親亦是透析病人死亡陰影衝擊下，心理產生極大壓力而出現不安及害怕之情緒反應，甚至拒絕透析。護理期間自2014年10月20日至2014年12月25日，運用整體性健康功能進行評估，以面對面會談、觀察、身體評估、病歷查閱等方式收集資料，確認主要健康問題有：體液容積過量、急性疼痛、舒適情況改變及心理調適障礙。藉由提供生理舒適及主動關懷、同理心等支持技巧，與個案建立良好護病關係；運用個別性護理及專業知識，提供個案血液透析照護手冊，積極與醫療團隊溝通及個案的行為修正，有效改善其生理層面問題。心理社會問題則提供個別、持續性護理，主動關懷個案需求，協助正向面對身體改變之事實；鼓勵表達內心感受，建構出新的自我價值，促使面對初次長期透析時能正向調適，希望此護理經驗可提供相關臨床人員，在照護初次血液透析病人之參考。
並列摘要
This article aims to discuss about the care of an ESRD patient with pulmonary edema and respiratory distress who needed hemodialysis to keep her life. She felt stressful, anxiety, and fear when she was told to be received hemodialysis in her later life because her mother died after hemodialysis. During the admission from October 20, 2014 to December 25, 2014, we used Gordon Functional Health Patterns to evaluate functional health status which includes interview, observation, physical examination and review of medical chart records. After collecting data, we confirmed the major nursing care problems such as: volume overload, acute tenderness, comfort circumstances change and psychological adjustment. We provided the physical comfort, active care, empathy to establish a good nurse-patient relationship. We used the individual nursing care, and professional knowledge to provide the hemodialysis care manual. We also improved the physiological aspect via correcting patient's behavior and communication with the whole medical team. In psychosocial level, we provided individual, persistent care, active rapport for demand, and encourage the expression of feeling to construct a new self-worth. According to the above process, she could positively face the initial long-term dialysis. In this article, we share our clinical nursing experience in the care of a patient initially receiving hemodialysis.