照護一位末期腎臟疾病人初次接受血液透析治療之護理經驗

Nursing Care Experiences of a Patient with End-stage Renal Disease (ESRD) Receiving the First Hemodialysis Treatment

10.6740/NTUHJN.202007_16(2).0004

龔柏仁(Po-Jen Kung)；詹君美(Chun-Mei Chan)；劉又瑛(Yu-Ying Liu)

微翻轉遊戲式學習 ； 末期腎臟病 ； 初次血液透析 ； 不確定感 ； mini-flipped game-based learning ； end-stage renal disease ； first hemodialysis ； uncertainty

臺大護理雜誌

16卷2期（2020 / 07 / 01）

29 - 40

繁體中文

本文探討一位末期腎病變的中年男性初次接受血液透析，出現對疾病之不確定感之照護經驗，護理期間自2019年3月28日至4月7日，經由直接照護、觀察、會談、身體評估及病歷查閱收集資料，確立個案主要健康問題為不確定感、體液容積過量及術後照護知識缺失。面對個案對治療之不確定感問題，團隊詳細介紹疾病及治療方式，以及其他病友經驗分享，讓個案能面對接受治療；透過飲食及活動指導，控制體液容積過量並增進舒適感；透析管路照護方式，以回覆示教確認換藥技巧之正確性，運用微翻轉遊戲式學習提升個案對照護的認知。建議臨床可運用微翻轉指導方式提升病人學習成效，對於初次接受血液透析病人，建議術前心理師或個管師能提早介入，使其具備良好的心理建設因應後續治療，術後也能有持續追蹤之居家照護機制。

This article discussed the nursing care experience of a male middle-aged patient with end-stage renal disease undergoing emergency hemodialysis. The nursing care period was from March 28 to April 7, 2019. Data were collected through direct care, observation, interview, physical assessment, and medical chart review. The main health problems were uncertainty, excessive body fluid volume, and insufficient knowledge regarding postoperative care. The multidiscipline team care model was established to reduce the patient's sense of uncertainty about the treatment. We applied mini-flipped game-based learning and provided instructions on diet and daily activities to control excessive body fluid volume. We provided postoperative wound and catheter care, instructed the patient how to handle the dialysis catheter, and demonstrated dressing change skills to reduce the patient's anxiety and increase his sense of control. An early intervention by a psychologist or case manager for patients receiving their first hemodialysis treatment will help them become mentally prepared for subsequent treatment and long-term care. This nursing care experience can be shared as a reference for clinical nurses caring for patients receiving their first hemodialysis treatment.