以羅氏適應理論護理一位初次血液透析患者之護理經驗

Nursing Care for Patient Undergoing the First Hemodialysis by the Roy's Adaptation Theory

呂佩佩(Pei-Pei Lu) ； 張玉珠(Yu-Chu Chang)

《長庚護理》 21卷1期 (2010/03) Pp. 100-108

https://doi.org/10.6386/CGN.201003_21(1).0011

摘要

本文描述一位42歲男性病患初次面臨洗腎之護理經驗。筆者於2006年12月14日至2007年01月16日間，以主責護士的角色進行照顧，藉由身體評估、會談及實際照護方式收集資料，以羅氏適應理論進行評估，歸納個案有體液容積過量、知識缺失及調適障礙之護理問題。在體液容積過量的護理過程中，筆者提供完整的攝入及排出記錄並協助連絡洗腎事宜，衛教個案體重監測及飲食重點。知識缺失的問題方面，先評估個案現有的腎病飲食概念，再合併個案獨立有主見的個性，凡事與個案一起討論、計劃及評值，教導個案與家屬將腎病飲食的注意事項融入日常生活中。針對角色調適障礙，筆者以傾聽及不批判的態度發揮感同身受的技巧，與個案建立良好的護病關係，接受個案現階段的調適狀況，並以不批判的態度看待個案對奇蹟的盼望，強化個案的正向認知調適策略並協助家屬、病友給予患者正向支持，有效陪伴個案渡過初次成爲血液透析患者之心理調適。建議職場上可設置工作人員交流的工作坊或是定期的集會，提供接觸病患時進退應對的經驗，以期因應洗腎人口增多的情況下，能在第一線提供最適切的護理照顧。

關鍵字

慢性腎衰竭 ； 初次洗腎 ； 羅氏適應理論

並列摘要

This article addresses the nursing experience of a 42-year-old male patient who underwent his first hemodialysis treatment. The duration of nursing care for this patient was from December 14, 2006 to January 16, 2007. In this study, the assessment of the patient, by using Roy's adaptation theory, revealed that the patient had retention of body fluids and ineffective adaptation to renal diet as well as role adjustment. The author kept a complete record of intake and output of the patient during the nursing process, in terms of retention of body fluids; and also assisted the patient in dialysis arrangement, weight monitoring and diet management. In addition, the author taught the patient how to put the renal diet into daily practice in a way that is simple and easy-to-understand. Due to the patient's mal-adaptation to dialysis, the patient's hope for a miracle cure was treated with empathy by the author. The author furthermore supported the patient's wish to seek religious consolation by going to temples to pray for recovery when his health was stable. It was found that family was a positive influential factor that could help the patient to establish his goals in life. Family is the most essential and important unit of humankind and civilization. Understanding the patient's family role prior to a clinical interview is helpful in constructing the whole picture of the patient's adaptation situation. It is suggested that patient's family tree and the information about his family interactions should be indicated in the nursing record. It is hoped that the nursing record can become the most valuable record among future medical records.

並列關鍵字

chronic renal failure ； first hemodialysis ； the Roy's adaptation theory