運用共享決策照護一位末期腎病病人面對透析模式選擇之護理經驗

Abstract

本文探討一位末期腎病於門診長期追蹤，突發心臟問題導致腎功能急速惡化，需長期透析治療之病人，面對健康狀況改變引發抉擇衝突之護理過程。於2020.12.15至2021.01.06，藉由觀察、會談、Gordon 11項功能性健康型態及身體評估等方式收集資料，歸納病人有抉擇衝突、營養少於身體所需、潛在危險性感染、及知識缺失之健康問題。過程中予以鼓勵、傾聽、支持，提供多元化衛教方式，增加對透析的認識，以醫病共享決策（Shared Decision Making, SDM）介入，協助病人依照意願選擇腹膜透析，成功學會居家治療方式及自我照顧。建議日後慢性腎臟病於門診追蹤時，醫護團隊提早計畫性介入SDM，提供相關識能及足夠時間讓病人及家屬做討論，及早思考，接受治療。  The nursing process of a patient facing conflicting choices caused by changes in health status who had chronic kidney disease with regular follow-up in an outpatient clinic and suddenly got cardiac problem leading to a rapid deterioration of renal function and thus required long-term dialysis treatment. From December 15th, 2020 to January 1st, 2021, the relevant data was collected through observation, interviews, and physical assessment by Gordon’s 11 Functional Health Patterns and conclude that this case have healthy issues of conflicting choices, less nutrition than physical needs, potentially dangerous infections, and knowledge deficit. In the process, nursing cares were provided through encouragement, listening, supporting, and providing diversified health education methods to increase knowledge of dialysis. Use shared decision making (SDM) to intervene and assist the patient to choose peritoneal dialysis according to personal wishes, and help the patient successfully learn home dialysis and self-care. In the future, it is recommended that when chronic kidney disease patients are follow-up in outpatient clinics, the medical team should plan in advance to intervene with SDM to provide relevant knowledge and leave enough time for patients and their families to discuss and think early for receiving treatment.