運用Watson理論於一位腎移植後急性排斥個案護理經驗

本文描述一位血液透析個案接受腎移植後出現急性排斥之護理經驗，照護期間為2020年1月6日至2020年1月31日。筆者藉由會談、傾聽、觀察、身體評估、病歷查閱等技巧收集資料，確立有急性疼痛、潛在危險性感染、焦慮等健康問題。運用Watson關懷照護理論，與個案建立良好的護病關係，提供個別性護理。針對術後急性疼痛，提供疼痛緩解技巧，如：呼吸控制等，並合併藥物介入，達到疼痛控制；潛在危險性感染風險，著重加強傷口照護，及出院後預防感染居家護理，加上雙重血漿置換後導致白蛋白低於正常值，更運用跨團隊會診營養師，提供高蛋白等營養攝取資訊；當對未來出現不確定，及對不熟悉的治療產生焦慮不安時，除給予治療前詳細介紹外，更運用關懷、聆聽、信仰等，加強其心理與靈性支持，增加個案的自信和希望，使其能以正向態度開始新生活。期望藉由此經驗分享在照護類似個案時，能提供更適切的護理照顧，作為日後臨床照護之參考。

關鍵字

活體腎移植；急性排斥； Watson理論；雙重血漿置換

並列摘要

This study describes the experience of providing nursing care to a hemodialysis patient who experienced acute rejection following a kidney transplant. The period of care lasted from January 6, 2020 to January 21, 2020. Data was collected through conversations, listening sessions, observations, physical assessments, and medical record reviews. The patient was found to be suffering from health problems such as acute pain, a potential risk of infection, and anxiety. Watson's theory of human caring was applied to establish a strong nurse-patient relationship and to provide personalized nursing care. The patient's acute postoperative pain was managed and controlled by means of pain alleviation methods such as respiratory control and medication treatment-based interventions. The patient's potential risk of infection was managed by focusing on the implementation of wound care as well as infection prevention measures at the patient's home after discharge. Furthermore, since the patient's albumin level was lower than normal following a double filtration plasmapheresis, a multidisciplinary team was formed, and the patient consulted with a dietician who provided nutritional recommendations such as having a high protein diet. When the patient expressed uncertainty about the future or felt anxious about unfamiliar treatments, the team not only thoroughly described the treatments beforehand, but also enhanced the mental and spiritual support that they provided by expressing concern about, listening to, and placing faith in the patient, with the purpose of boosting the patient's self-confidence and sense of hope. As a result the patient was able to begin a new life with a positive attitude. This experience is expected to serve as a reference for providing more appropriate nursing care plans for similar patients in clinical settings in the future.

並列關鍵字

living-donor kidney transplantation ； acute rejection ； Watson's theory ； double filtration plasmapheresis

參考文獻

王婉菁、蔡佳璋、王惠芳、侯玉琴、劉蕙婷、黃道民（2018）‧治療性血漿分離術之原理及應用‧腎臟與透析‧30（4），208-213。https://doi.org/10.6340/KD.201812_30(4).0010

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黃嘉宏、連榮達、吳明儒、陳呈旭、徐國雄（2019）‧台灣腎臟移植的過去、現在與未來‧內科學誌，30（1），34-41。https://doi.org/10.6314/JIMT.201902_30(1).07

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運用Watson理論於一位腎移植後急性排斥個案護理經驗

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