運用Mishel's不確定感理論於一位活體腎移植病人術後之護理經驗

Applying Mishel's Uncertainty Theory to the Care of a Patient After Living-Donor Kidney Transplantation: A Care Experience

方婷臬(Ting-Nien Fang) ； 林秋菊(Chiu-Chu Lin)

《護理雜誌》 63卷1期 (2016/02) Pp. 125-130

https://doi.org/10.6224/JN.63.1.125

摘要

有了腎臟移植手術的選擇，末期腎病變病人可以擺脫透析治療所帶來的痛苦；但在手術成功的同時，病人也須面對不同於透析治療的合併症及自我照護方式，且可能因不了解其相關的訊息，導致不確定感的產生。本文在探討一位接受活體腎臟移植的術後病人，在腎臟移植術後產生不確定感、甚至對預後感到憂心。筆者運用Mishel不確定感理論為評估架構，了解引起不確定感的導因，並在移植術後照護過程中，提供完整腎臟移植術後相關的訊息，使病人在指導下增進自我照護的知識及技巧，並利用自我紀錄的方式，使個案自我檢視目前疾病過程，減輕對預後不佳的猜測。最終在出院時，個案將不確定感轉化為治療的動力，積極的參與治療過程，也努力維持自我健康狀態。

關鍵字

不確定感理論 ； 活體腎移植 ； 移植術後照護

並列摘要

Kidney transplantation greatly benefits end-stage renal disease patients, as they no longer must bear the torment of hemodialysis. However, the effectiveness of living-donor kidney transplantation is often negatively impacted by various complications, which patients may learn to control through related self-care strategies. However, lack of information on these complications and related strategies may lead to feelings of uncertainty and worries over the prognosis. This article discusses a nursing experience with a patient who underwent living-donor kidney transplantation and who suffered from immense uncertainty and prognosis-related worry. Based on the assessment framework of Mishel’s uncertainty theory, the authors identified the cause of the subject’s uncertainty and offered thorough information regarding post-transplant care. During the period of care, the subject gained self-care knowledge and skills. Furthermore, he learned to apply self-recording, a technique that enabled him to self-monitor the progress of his disease progress, which reduced his sense of insecurity significantly. Ultimately, the subject turned uncertainty into motivation in order to actively participate in his treatment and to maintain optimum health status.

並列關鍵字

uncertainty theory ； living-donor kidney transplantation ； post-transplant care

參考文獻

周桂君、李明哲（2014）．腎臟移植的醫療照護現況．護理雜誌，61（4），15–20。[Chou, K. C., & Lee, M. C. (2014). Current management and care issues in kidney transplant recipients. The Journal of Nursing, 61(4), 15–20.] doi:10.6224/JN.61.4.15

李雅惠、汪慧鈴、李中一、蕭安穗、杜宗陽（2014）．探討護理指導方案經由改變不確定感刺激結構對不確定感之成效－初次罹患突發性聽力喪失病人．護理雜誌，61（3），36–44。[Lee, Y. H., Wang, H. L., Li, C. Y., Shiao, A. S., & Tu, T. Y. (2014). Exploring the effectiveness of a health education program on the stimuli frame and on uncertainty in patients with sudden hearing loss. The Journal of Nursing, 61(3), 36–44.] doi:10.6224/JN.61.3.36

蔡曉婷、周汎澔（2012）．多媒體護理指導緩解冠狀動脈成形術後心肌梗塞病患焦慮及疾病不確定感之成效．護理雜誌，59（4），43–53。[Tsai, S. T., & Chou, F. H. (2012). The effectiveness of multimedia nursing education on reducing illness-related anxiety and uncertainty in myocardial infarction patients after percutaneous coronary intervention. The Journal of Nursing, 59(4), 43–53.] doi:10.6224/JN.59.4.43

Arriola, K., Powell, C., Thompson, N., Perryman, J., & Basu, M. (2014). Living donor transplant education for African American patients with end-stage renal disease. Progress in Transplantation, 24(4), 362–370. doi:10.7182/pit2014830

De Pasquale, C., Veroux, M., Indelicato, L., Sinagra, N., Giaquinta, A., Fornaro, M., ... Pistorio, M. L. (2014). Psychopathological aspects of kidney transplantation: Efficacy of a multidisciplinary team. World Journal of Transplantation, 4(4), 267–275. doi:10.5500/wjt.v4.i4.267