運用Swanson關懷理論照顧一位不遵從血液透析病人之護理經驗

Abstract

本文旨在敘述一位不遵從血液透析治療療程病人之護理經驗。照護期間自2019年2月1日至6月3日，發現個案因飲食及水份自我控制差，導致透析過程中身體不適及影響透析品質，且由於個案無法接受增加透析次數，亦對未來感到無力、無助感，故以Gordon’s十一項功能性健康型態評估作為指引，歸納出主要健康問題為：體液容積過量、不遵從及無力感。筆者運用Swanson關懷理論中五個核心過程：「了解、在旁陪伴、為他做某些事、使他能夠、維持信念」，主動關懷個案需求，透過護理活動介入，協助個案獲得良好支持系統，以減輕個案內心之無力、無助感；加強對疾病深入認識了解，使其能以正向態度坦然並積極遵從血液透析治療，重建自我價值，提升對於未來的正向信念。建議對於處於疾病調適期的個案，醫護人員應該用正向角度看待個案，強調遵從的正向效果，誘發個案自我效能以重建信心。期望藉由此照護經驗，能提供護理人員對於血液透析病人照護之參考及運用。  This article aims to share our nursing experience of caring a noncompliant patient receiving maintenance hemodialysis. The patient had large interdialytic weight gain secondary to poor adherence to sodium and fluid restriction during February 1, 2019 to June 3, 2019. The frequent poor self-control of dietary water and inadequate dialysis made him extremely tired, uneasy, edematous, and despond. He was then in a depressive mood, feeling powerless and hopeless for the future. Gordon’s11 functional assessment tool was applied; we evaluated and categorized the patient’s health problems as fluid overload, noncompliance, and powerlessness. Based on Swanson’s Theory of Caring, the five key principles of care were knowing, being with, doing for, enabling, and maintaining belief. Through the patient-centered nursing process, we looked after his needs, utilized resources to get him a good support system, tried to regain his confidence in the fight against the illnesses, and alleviated his helplessness and powerlessness. By collaborating with the dialysis staff and handling the difficulties in a positive manner, the patient rebuilt his self-worth and optimistic attitude toward life. It is recommended that for patients with an adjustment disorder, the medical staff should treat them properly in a positive perspective, utilize available resources to develop a supportive system, reassure the importance of dietary and fluid compliance, and increase the patients’ self-confidence. We think that the nursing experience is a good example for professionals taking care of patients on hemodialysis.