協助一位初次接受血液透析病人調適生活之護理經驗

Nursing Experience of Caring for a Frist-Time Hemodialysis Patient Undergoing Life Adjustments

10.29494/LN.201806_19(2).0006

陳韋吟(Wei- Yin Chang)；黃秀文(Husi-Wen Huang)

末期腎病 ； 初次血液透析 ； 調適生活 ； first hemodialysis ； end stage renal disease ； lifestyle adaptation

領導護理

19卷2期（2018 / 06 / 01）

63 - 77

繁體中文

本文在描述照顧一位初次接受血液透析的末期腎病病人，學習適應與血液透析共處的生活方式、減輕不適之護理經驗。護理期間於2015年6月25日至8月10日，藉由介紹血液透析治療方式、透析前導管護理及每次透析中的會談及觀察與電話關懷等方式收集資料，並依羅氏適應理論進行評估。結果爲（一）體液容積過量／腎功能衰竭導致水份無法移除；（二）潛在危險性感染／與置放希克曼式導管及缺乏導管自我照護有關；（三）調適障礙／對透析治療的不了解與預期生活將受到衝擊。於照護過程先行建立護病關係，除了主動傾聽、溝通了解病人的需求外，更利用衛教的同時了解病人對洗腎飲食及知識的認知。發現病人在生活上的調適障礙，以同理的態度和病人建立良好的護病關係。主動提供知識並找出支持系統，介紹腎友經驗分享，給予病人正向支持，來陪伴病人渡過初次血液透析的焦慮，讓病人學習並擁有正確自我照顧能力。透過醫療團隊整合性照顧提供出院後續之持續性照顧，並提供後續協助，使病人對疾病能有較正向認知及積極治療的態度接受血液透析，讓病人能成功地適應血液透析的新生活。希冀藉此經驗提供照護末期腎病病人執行血液透析護理之參考。

The report covers the nursing experience of caring for a patient receiving hemodialysis for the first time with end-stage renal disease learning to adapt to lifestyle changes as well as learning how to ease the discomfort from hemodialysis treatments. Utilizing Roy's Adaptation Model to assess the patient, data was collected through introducing hemodialysis sessions and vascular access care before dialysis, communication, close observations and phone calls with the patient from June 25 to August 10, 2015. The main nursing problems were identified as follows: 1) Renal failure resulting in excessive fluid unable to be removed. 2) Risk of infection/double-lumen Hickman catheter implementation and lack of experience in the maintenance of the AV fistula in hemodialysis. 3) Difficulties in coping with unfamiliar hemodialysis sessions and expecting life-changing impacts through the procedure. First, the nurses established a therapeutic relationship with the patient to communicate with patient in order to fulfill their needs. In addition, informing the patient on proper dietary habits and the process of hemodialysis helped ease the fear of the procedures. Understanding that the patient was facing a difficult time and building a trusting relationship with a sympathetic attitude further improved the patient's ability to cope with the situation. The patient was also provided information regarding support systems and had people undergoing regular dialysis share their experiences to positively support the patient to cope with the anxiety of their first hemodialysis session. After the patient was discharged, they were provided with consistent care from a comprehensive medical care team to further allow the patient to accept the disease with a positive attitude. The patient had adjusted to the treatment and worked around it successfully and began to enjoy life after implementation of the above strategies. It is with hope that the report may be used as a reference for caring for end stage renal disease patients undergoing hemodialysis.

1. 翁嘉英,吳振能,吳英璋(2003)。『病人角色』的抗拒與接受：接受血液透析治療患者的心理調適歷程。中華心理衛生學刊，10(4)，49-82。
   連結：
2. 張素英,林惠瑛,楊麗瓊,藺寶珍(2015)。協助一位初透析病人面臨透析模式改變之照護經驗。志爲護理，14(2)，79-88。
   連結：
3. Feroze, U.,Martin, D.,Reina-Patton, A.,Kalantar -Zadeh, K.,Kopple, J. D.(2010).Mental health, depression, and anxiety in patients on maintenance dialysis.Iranian Journal of Kidney Diseases,4(3),173-180.
4. Nygordh, A.,Malm, D.,Wikby, K.,Ahlstrom, G.(2012).The experience of empowerment in the patientstaff encounter: the patient's perspective?.Journal of Clinical Nursing,21(5-6),897-904.
5. 王蔚芸,陳美容(2009)。體液容積過量之原理背景及護理。長庚護理，20(3)，334-342。
6. 白玉玲,丘周萍(2011)。血液透析病人體液容積過量的照護。源遠護理，5(1)，5-10。
7. 白玉玲,洪士元,李碧娥,賴柳元,丘周萍(2009)。血液透析病人疲憊的評估與處置。腎臟與透析，27(1)，43-47。
8. 呂佩佩,張玉珠(2010)。以羅氏適應理論護理一位初次血液透析病人之護理經驗。長庚護理，21(1)，100-108。
9. 林明彥,黃尚志(2010)。腎臟臟病臨床醫療與公共衛生的挑戰。高雄醫師會誌，18(4)，332-335。
10. 國家衛生研究院電子報(2015)．2015台灣腎病年報．http://enews.nhri.org.tw/enews_list _new2_more.php?volume_indx=643&showx =showarticle&article_indx=10962
11. 張慧蘭,車憶敏(2010)。運用行爲修正策略協助一位血液透析病人飲食控制與生活壓力適應的護理經驗。臺灣腎臟護理學會雜誌，9(2)，1-13。
12. 郭昭玲,方莉(2013)。照護一位末期腎病變初次血液透析病人之護理經驗。臺灣腎臟護理學會雜誌，12(1)，72-86。
13. 陳心儀,李美樺,陳筱瑀(2013)。一位末期腎病變病人初次接受血液透析之護理經驗。澄清醫護管理雜誌，9(3)，42-48。
14. 陳忠祺(2011).透析治療手冊.台北:愛思唯爾.
15. 陳芳慈(2015)。照顧一位首次血液透析病人心理調適過程之護理經驗。臺灣腎臟護理學會雜誌，13(1)，76-86。
16. 曾明晰(2012)。管維護秘笈─運用身評技巧於慢性透析病人動靜脈管的功能評估。臺灣腎臟護理學會雜誌，11(1)，20-23。

1. 林玉菁,李逸婷,吳培寧(2023)。照護一位老年血液透析患者導管傷口感染之護理經驗。長庚護理，34(2)，111-120。
2. 謝宜均,林曉芳,周小玉(2023)。提升護理人員執行希克曼導管居家照護衛教正確率。領導護理，24(2)，145-159。