應用運動訓練照護一位活動無耐力之血液透析病人的護理經驗

Application of Exercise Training to the Care of a Hemodialysis Patient with Activity Intolerance

10.3966/172674042017061602006

楊惠娟(Hui-Chuan Yang)；楊麗瓊(Li-King Yang)；劉月敏(Yueh-Min Liu)

血液透析 ； 活動無耐力 ； 疲憊 ； 無力感 ； 運動訓練 ； hemodialysis ； activity intolerance ； fatigue ； powerlessness ； exercisetraining

臺灣腎臟護理學會雜誌

16卷2期（2017 / 06 / 01）

73 - 89

繁體中文

本文旨在描述應用運動訓練照護一位長期接受血液透析病人合併活動無耐力、疲憊和無力感，造成的生理及心理衝擊的護理經驗。筆者自2016年4月1日至5月20日期間，運用觀察、會談、身體評估技巧及查閱病歷方式收集個案之整體性資料，歸納出個案有活動無耐力／長期血液透析治療、身體逐漸衰弱和缺少運動有關，疲憊／與肌肉抽筋、睡眠障礙和身體無力有關，無力感／對生活缺乏控制力、自信心低落之護理問題。筆者藉多次主動關懷，建立良好的醫護關係，予個案具個別性之護理活動，及採漸進式運動，逐漸增加身體活動力。運用內在自我復原力和外在社會支持系統，並鼓勵表達內心的感受，協助個案減輕疲憊，恢復正向思考，使個案能增強力量與信心，克服無力感，重新找到生命的意義與價值。期盼藉由此經驗能提供護理人員作為日後照顧類似病人的參考。

This article aims to apply exercise training to the care of a hemodialysis patient with physical and psychological problems caused by activity intolerance, fatigue and powerlessness. From April 1 to May 20, 2016, the author assessed the case via observation, in-depth interviews, physical examination, and medical records to collect information. The author identified health problems including activity intolerance/ hemodialysis treatment, gradual deterioration in health and lack of exercise, fatigue/ muscle cramps, sleep disorders and physical weakness, and powerlessness/ lack of control in life, low self-confidence. During the process of nursing care, a positive relationship was established through frequent contact, individual nursing activities conducted, and progressive exercise introduced to slowly increased physical energy. Internal resilience and external social support system were leveraged to encourage self-expression, reduce fatigue, and restore positive thinking. By enhancing the patient’s strength and confidence, this helped the patient overcome the sense of powerlessness and rediscover the meaning of life. The author hopes the care experience of a hemodialysis patient with activity intolerance, fatigue and powerlessness shared here can provide a useful reference to other nursing personnel in the care of similar patients.

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