運用醫病共享決策於末期腎臟病病人透析抉擇之照護經驗

Experience in Nursing: Using Sharing Decision-making on a patient in Dialysis Selection with End Stage Renal Disease

10.6692/KJN.202005/SP_37.0009

李君玫(Chun-Mei Lee)；朱璧岑(Pi-Chen Chu)

醫病共享決策 ； 血液透析 ； 動靜脈瘻管 ； 血液透析飲食 ； sharing Decision-making ； hemodialysis ； arteriovenous fistula ； diet treatment

高雄護理雜誌

37卷增訂刊（2020 / 05 / 01）

100 - 111

繁體中文

末期腎臟病人初次面臨抉擇腎臟替代療法，常因不瞭解及擔心長期照護問題，出現抉擇衝突，本文透過醫病共享決策，協助病人選擇適合的治療方式，並教導自我照護之方法經驗。筆者為病房護理師，於護理期間2017/11/18至2017/11/26，透過會談及觀察方式收集資料，運用生理、心理、社會、靈性四大層面為架構進行評估，確立個案有：「抉擇衝突」、「健康尋求行為」、「營養知識缺失」三項健康問題。措施包含：提供衛教影片及共享決策輔助表，配合動靜脈瘻管照片及腹膜透析模型，協助個案了解各種腎臟替代療法概念，考慮病人及家屬的偏好及選擇，提供相關衛教：動靜脈瘻管術後傷口照護、血液透析飲食攝取原則，成功減輕個案焦慮，正向面對後續照護問題。

The aim of this article is to explore the nursing experiences of a patient with end-stage renal disease who underwent first-time hemodialysis, using Shared Decision-Making when she was faced with a choice of renal replacement therapy. Between November 18, 2017 and November 26, 2017, the author assessed the patient's physical, psychological, social, and spiritual condition through interviews and observation. The client had three nursing problems: conflicting choices, health-seeking behaviors, and knowledge deficiency of nutrition. Through using Patient Decision Aids, providing an education film, sharing decision-making aids, arteriovenous fistula photos and peritoneal dialysis models all assisted the patient in understanding renal replacement therapy. The author provided information sheets on hemodialysis, set up experience-sharing on the knowledge of arteriovenous fistula operation and therapeutic diet while considering the preferences and choices of the patient and family members, reduced the patient's fear and anxiety in regard to hemodialysis, and encouraged her to face the impact of those illnesses with a positive attitude.

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