運用復原力於一位末期腎臟疾病病童之照護經驗

Abstract

本文描述一位十六歲末期腎臟疾病病童，於2010年開始血液透析治療，因病程複雜導致頻繁出入院，進而嚴重影響生活品質。臨床上透析病童少見，醫護人員缺乏照護經驗，故對症狀評估及執行護理措施等均有困難。護理其間於2020年6月20日至9月20日，透過聊天、遊戲等方法與案童建立良好治療性人際關係，藉由照護、觀察、身體評估等方式收集資料，評估案童四大層面健康問題，問題包含復原力障礙、舒適障礙及營養不均衡，運用復原力概念降低危險因子及提升保護因子，增加正向健康行為以適應疾病，啟動跨團隊照護改善其營養不均衡，運用舒適護理緩解不適症狀。建議護理人員運用關懷及復原力，賦能案童對自我照顧技巧，引導病童探索自我價值，以增強對疾病的適應與提升照護品質。  This article describes a 16-year-old child with end-stage renal disease who started hemodialysis in 2010. The severe and complicated disease led to frequent admissions and discharges, which seriously affected the quality of life. End-stage renal diseases requiring chronic dialysis are rare in childhood and adolescence. However, medical staff with lack of relevant care experience, have difficulty to assess symptoms and implement nursing measures. The duration of nursing care, from June 20 to September 20, 2020, through chatting, games and other methods to establish a good therapeutic relationship with the child and their family members. The author was through direct care, observation, revisited to identify the patient’s resilience in the dimensions of physiology, mental status, society, and spirituality. It is confirmed that there are three health problems: (1) resilience disorder, (2) comfort disorder, and (3) nutritional imbalance. Therefore, in the process of building trust in the nursing relationship and use the concept of resilience to provide individual caring schemes of patient and their families, reduce risk factors and improve protective factors, increase positive healthy behaviors to improve quality of life and adapt to diseases. The author also initiates cross-team care to improve the patient nutritional imbalances, relieve itching and pain symptoms with comfort care. It is recommended that use care and resilience to provide individual caring schemes based on the perspective and strengthen the recognition, self-caring techniques, and family supportive systems of patients, increasing patient perceptions of self-worth, restoring their confidence, promoting their adaption to their disease, and improving life of quality.