末期腎臟病及透析患者之安寧照護

Palliative Care for Patients with End-stage Renal Disease and Dialysis

10.6647/CN.202312_30(4).0002

楊舒雅(Shu-Ya Yang)

末期腎臟病 ； 血液透析 ； 腹膜透析 ； 安寧照護 ； 預立醫療 ； ESRD ； hemodialysis ； peritoneal dialysis ； palliative care ； advance directives

彰化護理

30卷4期（2023 / 12 / 01）

2 - 8

繁體中文;英文

台灣在2000年通過安寧緩和條例，並在2009年9月擴大照護對象，納入八大非癌症的末期病人，其中就包括末期腎臟病（end-stage renal disease, ESRD），其目的在於減少病人痛苦和避免無效侵入性的處置，如何將安寧緩和照護這個選項融入末期腎臟病的照護越來越受到重視。醫護人員應盡早與病患及家屬提及預立醫療自主計畫及死亡之議題，對於進入生命末期之透析病患漸進式的提供緩和醫療資訊並持續溝通繼續透析或終止透析之必要性，避免無效醫療，圓滿病患善終的自主心願，本篇文章將針對預立醫療指示及安寧緩和照護之推動、末期腎臟病及透析患者進入安寧照護之評估、透析護理人員於安寧照護的角色與功能、患者及家屬心理與心靈支持做探討，期望藉由此篇文章提供照護者參考。

Taiwan passed the palliative care regulations in 2000, and expanded the care objects to include eight categories involving non-cancer end-stage patients in September 2009, including end-stage renal disease (end-stage renal disease, ESRD). The purpose of palliative care is to reduce the suffering of patients and to avoid ineffective and invasive treatment. People pay more attention to integrate the option of palliative care into the end-stage renal disease. Medical staff should mention the issue of advance medical self-planning and good death to ESRD patients and their families as soon as possible, and gradually provide palliative medical information and continue to communicate the necessity of continuing dialysis or terminating dialysis to patients entering the end of life. This article will focus on the promotion of advance directives and palliative care, the assessment of nursing care for end-stage renal disease and dialysis patients into palliative care, the role and function of dialysis nurses in palliative care, and the discussion on the psychological and spiritual support of patients and their families. We hope this article will serve as a reference for caregivers.

1. 裘苕莙,吳欣怡,吳尚潔,陳美珠(2019)。腎臟科醫護人員預立醫療指示認知及推動意願之探討。臺灣腎臟護理學會雜誌，18(2)，1-12。
   連結：
2. Carswell, C.,Noble, H.,Reid, J.(2020).Conservative management of patients with end-stage kidney disease.Nursing Standard,35(6),43-50.
3. Kalantar-Zadeh, K.,Wightman, A.,Liao, S.(2020).Ensuring Choice for People with Kidney Failure - Dialysis, Supportive Care, and Hope.The New England Journal of Medicine,383(2),99-101.
4. Miller, H.,Tan, J.,Clayton, J. M.,Meller, A.,Hermiz, Q.,Zwar, N.,Rhee, J.(2019).Patient experiences of nurse-facilitated advance care planning in a general practice setting: a qualitative study.BMC Palliat Care,18(1),25.
5. Moss, A. H.(2010).Revised dialysis clinical practice guideline promotes more informed decision-making.Clinical journal of the American Society of Nephrology : CJAS,5(12),2380-2383.
6. Raudonis, B. M.,Kirschling, J. M.(1996).Family caregivers’ perspectives on hospice nursing care.Journal of Palliative Care,12(2),14-19.
7. Ren, Q.,Shi, Q.,Ma, T.,Wang, J.,Li, Q.,Li, X.(2019).Quality of life, symptoms, and sleep quality of elderly with end-stage renal disease receiving conservative management: a systematic review.Health and quality of life outcomes,17(1),1-9.
8. Salmi, I. A.,Kamble, P.,Eilean, R. L.,D’Souza, Melba Sheila,Maimani, Y.A.,Hannawi, S.(2021).Kidney disease-specific quality of life among patients on hemodialysis.International Journal of Nephrology,2021
9. 林翠玲,劉薏婷,李慶玟,賴俊夫,胡文郁(2022)。末期腎臟病人之安寧緩和護理。腎臟與透析，34(1)，32-35。
10. 國家衛生研究院、台灣腎臟醫學會．2021台灣腎病年報。https://lib.nhri.edu.tw/NewWeb/nhri/ebook/39000000472774/#p=78
11. 陳佳其,施至遠,吳建志(2022)。末期腎臟病人安寧緩和醫療藥物使用指引。腎臟與透析，34(1)，36-43。
12. 陳怡汝,熊育敏,賴俊夫,陳永銘(2022)。腎臟病人的臨床預後及生活功能評估。腎臟與透析，34(1)，1-6。
13. 陳淑雅,胡文郁,楊郁,何昌益,石芬芬,陳慶餘(2010)。從安寧緩和療護視角揭露血液透析病人對末期疾病預立醫療計畫的看法。安寧療護雜誌，15(3)，269-288。
14. 黃煥智,吳建誼,莊昀璇,龔蘭芳,郭美娟,方姿蓉(2022)。高齡晚期腎臟病患者選擇安寧緩和照護之分析。台灣老誌，17(3)，208-220。
15. 黃獻樑,程劭儀,朱宗信(2022)。以勝任能力為導向的腎臟病安寧緩和教育。腎臟與透析，34(1)，44-47。
16. 詹雅婷,賴俊夫,蔡宏斌,姚建安,洪冠予(2016)。血液透析的安寧緩和治療: 如何給予停止血液透析的病患症狀緩和治療。腎臟與透析，28(1)，43-47。
17. 衛生福利部（2019）．預立醫療決定、安寧緩和醫療及器官捐贈意願資訊系統。https://hpcod.mohw.gov.tw/HospWeb/
18. 鄭靜宜,賴俊夫,姚建安,姜至剛(2022)。腹膜透析病人的安寧緩和醫療。腎臟與透析，34(1)，26-31。