協助一位老年患者面臨終生血液透析無力感之護理經驗

The Nursing Experience of Assisting an Elderly Patient with Helplessness in Undergoing Hemodialysis

10.6386/CGN.201909_30(3).0010

侯盈卉(Ying-Hui Hou)；林仲祺(Chung-Chi Lin)；張麗君(Li-Chun Chang)

血液透析 ； 老年 ； 無力感 ； hemodialysis ； elderly ； helplessness

長庚護理

30卷3期（2019 / 09 / 01）

396 - 406

繁體中文

本文描述一位老年女性患者因急性腎損傷後進展至末期腎病變，需面臨長期血液透析治療之護理經驗。護理期間自2017/4/11至6/30，照護時發現個案缺乏家庭支持而獨自承受生、心理及社會層面等壓力，故筆者運用觀察、會談、查閱病歷和電訪收集資料，依Gordon十一項健康功能型態評估，確立有舒適障礙、潛在危險性感染與無力感等健康問題；護理過程中深入了解個案內心想法，透過個別性護理措施、尋求社會支持，並將家屬列入照護對象，以強化家庭支持系統，同時亦藉由腎友交流，協助以正向態度將透析治療融入晚年生活，使其及早渡過壓力調適過程。

This article describes the nursing experience of caring an elderly female patient suffering from acute kidney injury (AKI) initially, and later progressed to end-stage renal disease (ESRD), leading her to receive long-term hemodialysis (HD). During the nursing period from April 11 to June 30 in 2017, we found that the patient lacked family support and was under physical, psychological, and social pressures alone. Therefore, observation, conversation, medical record review, and telephone interview were used to gather information and assess the health problems, following Gordon's 11 functional health patterns assessment tool. The problems included comfort impaired, risk of infection, and sense of helplessness. During the nursing process, the author deeply understood the patient's inner thoughts, arranged individualized nursing care interventions, sought social support, enrolled her family members as a part of care recipients to strengthen the family support system, and furthered the exchange of experience between dialysis patients. Through these measures, the author helped the patient face dialysis treatment with a positive attitude and overcome difficulties with efforts.

1. Miller, L. M.,Clark, E.,Dipchand, C.,Hiremath, S.,Kappel, J.,Kiaii, M.,MacRae. J.(2016).Hemodialysis tunneled catheterrelated infections.Canadian Journal of Kidney Health and Disease,3,1-11.
2. Sahaf, R.,Ilali, E. S.,Peyrovi, H.,Akbari Kamrani, A. A.,Spahbodi, F.(2017).Uncertainty, the Overbearing Lived Experience of the Elderly People Undergoing Hemodialysis: A Qualitative Study.International Journal of Community Based Nursing and Midwifery,5(1),13-21.
3. Scherer, J. S.,Combs, S. A.,Brennan, F.(2017).Sleep Disorders, Restless Legs Syndrome, and Uremic Pruritus: Diagnosis and Treatment of Common Symptoms in Dialysis Patients.American Journal of Kidney Disease,69(1),117-128.
4. Silva, S. M.,Braido, N. F.,Ottaviani, A. C.,Gesualdo. G. D.,Zazzetta. M. S.,Orlandi, F. S.(2016).Social support of adults and elderly with chronic kidney disease on dialysis.Revista Latino-Americana de Enfermagem,24,1-7.
5. Soi, V.,Moore, C. L.,Kumbar, L.,Yee, J.(2016).Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies.International Journal of Nephrology and Renovascular Disease,9,95-103.
6. 王秀鑾、姜美珠(2014)。影響血液透析病人之適當透析醫療照護因素的探討。2013 南台灣健康照護產業暨健康產業國際學術研討會，屏東縣:
7. 王魯梅、丘周萍(2011)。無力感的概念分析及其於透析護理的應用。臺灣腎臟護理學會雜誌，10(3)，1-9。
8. 台灣腎臟醫學會(2017)。2017台灣腎病年報。
9. 林偉弘、郭冠良、夏清智、吳岱穎、陳建志(2013)。淺談慢性腎臟病。北市醫學雜誌，10(2)，101-109。
10. 高治圻、許巧縈、張芳綺、林彥仲、吳麥斯、陳振文、陳錫賢(2015)。慢性腎衰竭病人的鈣、磷代謝異常之飲食對策。腎臟與透析，27(3)，107-110。
11. 張凱迪、陳殷正、賴俊夫、林水龍、蔡敦仁(2014)。Now and Forever： 急性腎損傷之長期影響。內科學誌，25(2)，82-85。
12. 黃淑鈴、蔡佳璋、陳美伶、黃小倩、姜遠萍、徐永堂、黃政文(2016)。血液透析之感染管制。腎臟與透析，28(2)，101-105。
13. 黃勝梅、王素琴、林秀慧、邱百群(2014)。血液透析病患雙腔靜脈導管感染率改善專案。臺灣腎臟護理學會雜誌，13(3)，41-56。
14. 雷若莉、許維民(2016)。老年慢性腎病患者之心理社會問題探討。腎臟與透析，28(3)，138-141。
15. 劉冠宏、郭依婷、吳安邦(2016)。血液透析常見的併發症。腎臟與透析，28(4)，164-167。
16. 鄭子娟(2014)。糖尿病腎病變（DM Nephropathy）。嘉基藥訊，112，6-8。
17. 謝永堃(2014)。淺談血液透析通路。血管醫學防治季刊，17，18-19。