協助一位初次血液透析患者建立長期透析生活之護理經驗

Nursing Care Experience of Assisting an Initial Hemodialysis Patient to Establish Long-term Dialysis Life

10.6647/CN.202103_28(1).0010

鍾惠琴(Hui-Chin Chung)；鍾玉珠(Yu-Chu Chung)

初次血液透析 ； 潛在危險性感染 ； 無效性健康管理 ； 無力感 ； First-time hemodialysis ； risk for infection ； ineffective self-health management ； powerlessness

彰化護理

28卷1期（2021 / 03 / 01）

96 - 107

繁體中文

本文旨在探討一位血液透析患者初次接受透析治療之護理經驗，護理期間自2019年7月19日至9月30日，利用Gordon十一項健康功能型態進行護理評估，藉由會談、觀察、身體評估及查閱病歷方式收集資料，確立個案主要的護理問題為潛在危險性感染、無效性健康管理及無力感。照護期間依個案之個別性，運用主動關懷、同理心及傾聽方式，鼓勵個案表達內心感受，提供血液透析相關知識、飲食指導及衛教單張來協助個案建立正確知識，建立良好飲食習慣及提升自我照顧能力，並以正面態度來面對長期透析。藉由護理指導方式和醫療團隊合作及家庭支持系統的發揮，讓個案成功接受與建立長期透析生活，進而回復往常生活與工作。

The purpose of this article is to describe the nursing experience of assisting an initial hemodialysis patient to establish long-term dialysis life. The nursing period was from July 19 to September 30, 2019. Data was collected by observation, interview, physical examination, and chart review. Gordon's 11 functional health patterns were applied for systemic evaluation. Three nursing problems were identified including risk for infection, ineffective self-health management, and powerlessness. During the nursing period, according to the individuality of the patient, use active caring, empathy and listening methods to encourage patient to express needs and inner feelings, provide hemodialysis related knowledge, dietary guidance, and education leaflets to help patient build correct knowledge, establish good eating habits, increase self-care ability, and be positive attitude to face long-term hemodialysis. With the help of nursing guidance, medical team cooperation and family support system, the patient can successfully accept and establish a long-term dialysis life, and then patient resumed his ordinary life and work.

1. Wang, L. M.,Chiou, C. P.(2011).Effectiveness of interactive multimedia CD on self-care and powerlessness in hemodialysis patients.The Journal of Nursing Research,19(2),102-111.
   連結：
2. Aflakseir, A. A.,Mohammad-Abadi, M. S.(2016).The role of health locus of control in predicting depression symptoms in a sample of Iranian older adults with chronic diseases.Iranian Journal of Psychiatry,11(2),82-86.
3. Beigi, A. A.,Sharifi, A.,Gaheri, H.,Abdollahi, S.,Esfahani, M. A.(2014).Placement of long-term hemodialysis catheter (permcath) in patients with end-stage renal disease through external jugular vein.Advanced Biomedical Research,3,252.
4. Bradshaw, M.,Ellison, C. G.,Fang, Q.,Mueller, C.(2015).Listening to religious music and mental health in later life.The Gerontologist,55(6),961-971.
5. Duff, E. A.,Chawke, F. M.(2017).A service review to assess if innovative intensive phosphate dietary education can help reduce phosphate levels to the recommended range in a hemodialysis population.Hemodialysis International,21(Suppl 2),S22-S26.
6. Hamid, H. A.,Bouanane, H.,Ibrahim, A.,Ismail, S.,El Sayed, A.,Mahmoud, K. M.,Hamad, A.,Al Ali, F.(2019).Effective prevention bundle to eliminate catheter-related bloodstream infections in ambulatory hemodialysis patients.Canadian Journal of Infection Control,34(1),54-57.
7. Hendriks, F. K.,Smeets, J. S. J.,Broers, N. J. H.,van Kranenburg, J. M. X.,van der Sande, F. M.,Kooman, J. P.,van Loon, L. J. C.(2020).End-stage renal disease patients lose a substantial amount of amino acids during hemodialysis.The Journal of Nutrition,150(5),1160-1166.
8. Ikenoue, T.,Koike, K.,Fukuma, S.,Ogata, S.,Iseki, K.,Fukuhara, S.(2018).Salt intake and all-cause mortality in hemodialysis patients.American Journal of Nephrology,48(2),87-95.
9. Rakhshan, M.,Mirshekari, F.,Dehghanrad, F.(2020).The relationship between illness perception and self-care behaviors among hemodialysis patients.Iranian Journal of Psychiatry,15(2),150-158.
10. Shih, S. N.,Shih, F. J.,Chen, C. H.,Lo, C. H.(2000).The forgotten faces: The lonely journey of powerlessness experienced by elderly single Chinese men with heart disease in Taiwan.Geriatric Nursing,21(5),254-259.
11. St-Jules, D. E.,Goldfarb, D. S.,Pompeii, M. L.,Liebman, S. E.,Sherman, R. A.(2018).Assessment and misassessment of potassium, phosphorus, and protein in the hemodialysis diet.Seminars in dialysis,31(5),479-486.
12. Tu, H. Y.,Shao, J. H.,Wu, F. J.,Chen, S. H.,Chuang, Y. H.(2014).Stressors and coping strategies of 20-45-year-old hemodialysis patients.Collegian,21(3),185-192.
13. Yusuf, A. A.,Hu, Y.,Singh, B.,Menoyo, J. A.,Wetmore, J. B.(2016).Serum potassium levels and mortality in hemodialysis patients: A retrospective Cohort study.American Journal of Nephrology,44(3),179-186.
14. 吳紅蓮(2015)。透析病人殘餘腎功能之重要性─控制飲食的鹽分及水分之應用。腎臟與透析，27(2)，98-102。
15. 葉月珍,馬素華(2002)。“無力感＂之概念分析。長庚護理，13(2)，146-151。
16. 衛生福利部中央健康保險署（2020，5月18日）．全民健康保險重大傷病證明實際有效領證統計表．取自https://www.nhi.gov.tw/Content _List.aspx?n=D529CAC4D8F8E77B&topn=23C660CAACAA159D
17. 衛生福利部統計處（2020，6月15日）．108年死因統計結果分析．取自https://dep.mohw.gov.tw/DOS/np-1776-113.html

1. (2023)。照護一位卵巢癌末期病患無力感之護理經驗。中科大學報，10(1)，29-42。