照護一位因藥物濫用初次接受血液透析個案之護理經驗

Abstract

本文探討一位因長期藥物濫用致腎衰竭，需接受血液透析治療，於住院期間及出院後透析時，引發生理、心理和社會衝擊之護理經驗。筆者於2019年01月08日至2019年03月30日，運用羅氏適應模式，藉由直接護理、身體評估、觀察、傾聽、會談及查閱病歷等技巧收集相關資料，確立健康問題有：體液容積過量、潛在危險性感染及因應能力失常等。運用接納關懷建立良好護病關係，給予個別性、整體性護理措施。教導水分控制及導管照護知識，提升自我照顧能力，並照會社工師跨團隊照護，協助案父申請長照2.0服務，及急難補助金、就業服務站、民間戒毒團體等資源，使其接受血液透析造成的生活改變，以正向態度面對未來生活；建議定期舉辦跨領域、跨專業討論，如：每月舉辦跨團隊討論會，邀請民間及政府相關人員到院演講，使護理人員運用不同專業，提供適切護理照顧，期望藉由此經驗，為日後臨床照護之參考。  This article discusses the nursing experience of a patient who required hemodialysis treatment for kidney failure caused by long-term drug abuse and the associated physical, psychological, and social shocks during hospitalization and dialysis after hospital discharge. From January 8, 2019 to March 30, 2019, Roy’s adaptation model of nursing was used to collect relevant information through techniques of direct care, physical assessment, observation, listening, interviews, and medical record review. Fluid overload, potentially dangerous infections, and response malfunction were observed in the patient. Meanwhile, acceptance therapy was used to establish a good nurse-patient relationship and to provide individualized as well as holistic care measures. The patient was provided knowledge on water control and catheter care to improve his self-care ability; social workers were also available for cross-team care. Furthermore, the patient was provided assistance in applying for long-term care 2.0 services, as well as for accessing resources from emergency subsidies, employment service stations, and private drug treatment groups to enable him to accept changes in his life caused by hemodialysis and to help him maintain a positive attitude toward life. It is recommended to schedule multi-disciplinary and cross-professional discussions, such as monthly cross-team discussions inviting private and government personnel to deliver lectures, on a regular basis to help the nursing staff make the best use of the different healthcare professionals to provide appropriate nursing care. The nursing experience reported here is expected to serve as a reference for future clinical care.