Pub Date : 2023-12-01DOI: 10.53106/172674042023122201003
邱雅鈴 邱雅鈴, 林仲祺 林仲祺, 梁家榕 梁家榕
本文描述一位老年糖尿病腎病變併慢性腎臟病第四期個案，選擇未來接受血液透析治療並預先建立動靜脈瘻管，在缺乏心理準備下即進入透析治療階段，治療初期因對自我照顧方式不了解，而引發焦慮情緒之護理經驗。護理期間自2020年2月18日至3月31日，筆者運用五大層面進行整體性評估與收集資料，確立個案有體液容積過量、健康維護能力失常、焦慮之健康問題；護理期間提供個別性照護措施，使個案進而適應老年透析生活。建議未來可將透析護理指導製作成衛教影片，並編製QR code條碼使透析患者及家屬能透過智慧型手機的普遍性與便利性即時獲取衛教資訊，對於強化其自我照顧能力及提升老年透析生活品質達雙重之效。 This article describes the nursing experience of caring an elderly diabetic nephropathy and stage 4 chronic kidney disease patient received arteriovenous fistula creation after decided hemodialysis treatment, leading him to long-term hemodialysis without preparation and felt anxious due to lack of self-care ability. During nursing period from February 18 to March 31, 2020, following the five major aspects, the problems included excessive fluid volume, ineffective health maintenance, and anxiety. During the nursing process, the author provided individual care to help patient adapted to the elderly dialysis life. Make dialysis health education video, generate QR code can help dialysis patients and families obtain health education information immediately through the universality and convenience of smartphones, which can have a dual effect on strengthening self-care ability and improving the quality of elderly dialysis life.
{"title":"提升一位老年患者初接受血液透析自我照顧能力之護理經驗","authors":"邱雅鈴 邱雅鈴, 林仲祺 林仲祺, 梁家榕 梁家榕","doi":"10.53106/172674042023122201003","DOIUrl":"https://doi.org/10.53106/172674042023122201003","url":null,"abstract":"本文描述一位老年糖尿病腎病變併慢性腎臟病第四期個案，選擇未來接受血液透析治療並預先建立動靜脈瘻管，在缺乏心理準備下即進入透析治療階段，治療初期因對自我照顧方式不了解，而引發焦慮情緒之護理經驗。護理期間自2020年2月18日至3月31日，筆者運用五大層面進行整體性評估與收集資料，確立個案有體液容積過量、健康維護能力失常、焦慮之健康問題；護理期間提供個別性照護措施，使個案進而適應老年透析生活。建議未來可將透析護理指導製作成衛教影片，並編製QR code條碼使透析患者及家屬能透過智慧型手機的普遍性與便利性即時獲取衛教資訊，對於強化其自我照顧能力及提升老年透析生活品質達雙重之效。 This article describes the nursing experience of caring an elderly diabetic nephropathy and stage 4 chronic kidney disease patient received arteriovenous fistula creation after decided hemodialysis treatment, leading him to long-term hemodialysis without preparation and felt anxious due to lack of self-care ability. During nursing period from February 18 to March 31, 2020, following the five major aspects, the problems included excessive fluid volume, ineffective health maintenance, and anxiety. During the nursing process, the author provided individual care to help patient adapted to the elderly dialysis life. Make dialysis health education video, generate QR code can help dialysis patients and families obtain health education information immediately through the universality and convenience of smartphones, which can have a dual effect on strengthening self-care ability and improving the quality of elderly dialysis life.","PeriodicalId":509550,"journal":{"name":"臺灣腎臟護理學會雜誌","volume":"17 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.53106/172674042023122201004
李子瑜 李子瑜, 林嘉慧 林嘉慧, 黃羿華 黃羿華
本文敘述一位血液透析個案合併周邊動脈阻塞疾病導致傷口惡化面臨左膝下截肢，截肢後的外觀及結構改變，造成其心理巨大的衝擊與震撼。護理期間於2021年4月8日至2021年6月30日，運用Gordon十一項健康功能型態進行整體評估，藉由會談、護理、觀察及傾聽技巧收集資料，確立個案有營養不均衡:少於身體需要、身體活動功能障礙及身體心像紊亂之健康問題。照護期間利用蛋白質替換食譜QR code，採循序漸進的飲食計畫改善營養狀態，教導家屬截肢後產生的身體功能障礙和負面情緒之照護技巧，運用主動關懷、陪伴、引導其表達內心感受、鼓勵家人參與陪伴支持。照顧截肢病人在面對此段挫敗的人生經歷，醫療人員應積極協助面對不可逆的合併症，並提升其自我照護知識與能力，重建正向態度找回自我控制權迎向新生活。 This article describes the nursing experience of a hemodialysis patient with PAOD receiving below-knee amputation. The appearance and structural changes of the amputated limb had a huge psychological impact and shock. The nursing period was from April 8 to June 30, 2021, using Gordon’s 11 Functional Health Patterns were to collect information through direct care, observation, medical records and interviews. Identified problems included inadequate nutrition, impaired physical mobility and body image disturbance. During the nursing process, provided individualized nursing, designed protein exchange recipe guided by QR code, monitored his nutritional status and taught his family after amputation care skill. The author performed active caring and accompanied him to guide him express his deep mind feelings and to encourage his family to give support and accompany. Medical professionals should actively help amputees face irreversible complications, enhance their knowledge and self-care skills, rebuild positive attitudes, regain self-control and move forward to a new life.
{"title":"一位血液透析病人罹患周邊動脈阻塞疾病併發截肢之護理經驗","authors":"李子瑜 李子瑜, 林嘉慧 林嘉慧, 黃羿華 黃羿華","doi":"10.53106/172674042023122201004","DOIUrl":"https://doi.org/10.53106/172674042023122201004","url":null,"abstract":"本文敘述一位血液透析個案合併周邊動脈阻塞疾病導致傷口惡化面臨左膝下截肢，截肢後的外觀及結構改變，造成其心理巨大的衝擊與震撼。護理期間於2021年4月8日至2021年6月30日，運用Gordon十一項健康功能型態進行整體評估，藉由會談、護理、觀察及傾聽技巧收集資料，確立個案有營養不均衡:少於身體需要、身體活動功能障礙及身體心像紊亂之健康問題。照護期間利用蛋白質替換食譜QR code，採循序漸進的飲食計畫改善營養狀態，教導家屬截肢後產生的身體功能障礙和負面情緒之照護技巧，運用主動關懷、陪伴、引導其表達內心感受、鼓勵家人參與陪伴支持。照顧截肢病人在面對此段挫敗的人生經歷，醫療人員應積極協助面對不可逆的合併症，並提升其自我照護知識與能力，重建正向態度找回自我控制權迎向新生活。 This article describes the nursing experience of a hemodialysis patient with PAOD receiving below-knee amputation. The appearance and structural changes of the amputated limb had a huge psychological impact and shock. The nursing period was from April 8 to June 30, 2021, using Gordon’s 11 Functional Health Patterns were to collect information through direct care, observation, medical records and interviews. Identified problems included inadequate nutrition, impaired physical mobility and body image disturbance. During the nursing process, provided individualized nursing, designed protein exchange recipe guided by QR code, monitored his nutritional status and taught his family after amputation care skill. The author performed active caring and accompanied him to guide him express his deep mind feelings and to encourage his family to give support and accompany. Medical professionals should actively help amputees face irreversible complications, enhance their knowledge and self-care skills, rebuild positive attitudes, regain self-control and move forward to a new life.","PeriodicalId":509550,"journal":{"name":"臺灣腎臟護理學會雜誌","volume":"231 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.53106/172674042023122201002
陳燁 陳燁, 陳珍緯 陳珍緯
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.
{"title":"運用復原力於一位末期腎臟疾病病童之照護經驗","authors":"陳燁 陳燁, 陳珍緯 陳珍緯","doi":"10.53106/172674042023122201002","DOIUrl":"https://doi.org/10.53106/172674042023122201002","url":null,"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.","PeriodicalId":509550,"journal":{"name":"臺灣腎臟護理學會雜誌","volume":"27 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.53106/172674042023122201006
黃琳貴 黃琳貴, 劉月敏 劉月敏, 潘美卉 Yueh-Min Liu
背景：血液透析病人有疲倦和睡眠困難等身體症狀困擾，會影響其日常生活與活動，導致生活品質低下。 目的：探討血液透析病人身體症狀困擾、睡眠品質與生活品質之相關性。 方法：採橫斷式調查，研究對象共114位，以某區域教學醫院之血液透析病人為對象，以身體症狀困擾量表、中文匹茲堡睡眠品質量表、台灣簡明版世界衛生組織生活品質結構式問卷收集資料，通過IRB審查，取得編號:CTH-109-3-5-059，並於110年1/16至110年2/20期間收案，資料以描述性及相關性統計分析。 結果：研究對象共114位，血液透析病人身體症狀困擾依序前五名為睡眠困難、疲倦、便秘或腹瀉、皮膚癢、肌肉抽筋，且有43.8%的病人自覺睡眠品質不佳的情形，身體症狀困擾與睡眠品質呈中度正相關，與生活品質呈中度負相關，而睡眠品質與生活品質則達顯著中度負相關。 結論與應用：結果顯示身體症狀困擾越多，睡眠品質越差，生活品質越低。建議臨床護理人員幫助改善病人的身體症狀，讓病人獲得更好的睡眠品質和生活品質。 Backgrounds: Hemodialysis patients suffer from physical symptoms such as fatigue and difficulty sleeping, which affect daily life and activities, resulting in low quality of life. Objective: The purpose of this study is to investigate the relationship among physical symptom distress, sleep quality, and quality of life in hemodialysis patients. Methods: A cross-sectional and correlational design was utilized in this study, and a total of 114 participants were collected by convenience sampling from the regional teaching hospital in Taiwan. The research instruments include the symptom distress scale, the Chinese edition of the Pittsburg Sleep Quality Index, and the Taiwan edition of the brief version of World Health Organization Quality of Life scale. The data collected through the questionnaire passed the IRB review and obtained the serial number: CTH-109-3-5-059, and the case was accepted during the period from January 16, 2010 to February 20, 2010. The data were analyzed by descriptive and correlation statistics. Results: The top five physical symptoms of hemodialysis patients were sleep difficulty, fatigue, constipation or diarrhea, itchy skin, and muscle cramps. 43.8% of hemodialysis patients had poor sleep quality. There was a positive correlation between sleep quality (r=.57, p＜.01), and a negative correlation between physical symptoms and quality of life (r=-.56, p＜.01), and a negative correlation between sleep quality and quality of life(r=-.49, p＜.05). Conclusion and Application: The results show that the higher the physical symptoms, the worse the sleep quality, and the lower the quality of life. It is recommended that clinical medical staff help improve the patient’s physical symptoms, so that patients can get better sleep quality and quality of life.
{"title":"探討血液透析病人身體症狀困擾、睡眠品質與生活品質之相關性","authors":"黃琳貴 黃琳貴, 劉月敏 劉月敏, 潘美卉 Yueh-Min Liu","doi":"10.53106/172674042023122201006","DOIUrl":"https://doi.org/10.53106/172674042023122201006","url":null,"abstract":"背景：血液透析病人有疲倦和睡眠困難等身體症狀困擾，會影響其日常生活與活動，導致生活品質低下。 目的：探討血液透析病人身體症狀困擾、睡眠品質與生活品質之相關性。 方法：採橫斷式調查，研究對象共114位，以某區域教學醫院之血液透析病人為對象，以身體症狀困擾量表、中文匹茲堡睡眠品質量表、台灣簡明版世界衛生組織生活品質結構式問卷收集資料，通過IRB審查，取得編號:CTH-109-3-5-059，並於110年1/16至110年2/20期間收案，資料以描述性及相關性統計分析。 結果：研究對象共114位，血液透析病人身體症狀困擾依序前五名為睡眠困難、疲倦、便秘或腹瀉、皮膚癢、肌肉抽筋，且有43.8%的病人自覺睡眠品質不佳的情形，身體症狀困擾與睡眠品質呈中度正相關，與生活品質呈中度負相關，而睡眠品質與生活品質則達顯著中度負相關。 結論與應用：結果顯示身體症狀困擾越多，睡眠品質越差，生活品質越低。建議臨床護理人員幫助改善病人的身體症狀，讓病人獲得更好的睡眠品質和生活品質。 Backgrounds: Hemodialysis patients suffer from physical symptoms such as fatigue and difficulty sleeping, which affect daily life and activities, resulting in low quality of life. Objective: The purpose of this study is to investigate the relationship among physical symptom distress, sleep quality, and quality of life in hemodialysis patients. Methods: A cross-sectional and correlational design was utilized in this study, and a total of 114 participants were collected by convenience sampling from the regional teaching hospital in Taiwan. The research instruments include the symptom distress scale, the Chinese edition of the Pittsburg Sleep Quality Index, and the Taiwan edition of the brief version of World Health Organization Quality of Life scale. The data collected through the questionnaire passed the IRB review and obtained the serial number: CTH-109-3-5-059, and the case was accepted during the period from January 16, 2010 to February 20, 2010. The data were analyzed by descriptive and correlation statistics. Results: The top five physical symptoms of hemodialysis patients were sleep difficulty, fatigue, constipation or diarrhea, itchy skin, and muscle cramps. 43.8% of hemodialysis patients had poor sleep quality. There was a positive correlation between sleep quality (r=.57, p＜.01), and a negative correlation between physical symptoms and quality of life (r=-.56, p＜.01), and a negative correlation between sleep quality and quality of life(r=-.49, p＜.05). Conclusion and Application: The results show that the higher the physical symptoms, the worse the sleep quality, and the lower the quality of life. It is recommended that clinical medical staff help improve the patient’s physical symptoms, so that patients can get better sleep quality and quality of life.","PeriodicalId":509550,"journal":{"name":"臺灣腎臟護理學會雜誌","volume":"31 7-8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139193793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.53106/172674042023122201001
何育菁 何育菁, 李麗君 李麗君
本文為探討一位60歲女性末期腎病患者，在轉換不同透析治療模式時造成生理與心理的健康衝擊及適應困難之護理經驗。筆者於2020年1月6日至12月31日照護期間利用Gorden 十一項健康功能型態進行評估。確認個案主要護理問題為體液容積過量、焦慮和無望感。藉由相關護理指導使個案了解體液容積過量與飲食、水份的控制對改善水腫的重要性；提供個別性護理與個案共同規劃穿刺計畫、配合局部麻醉藥膏使用，降低因為穿刺引起之焦慮；傾聽個案不安，協助調整透析安排、鼓勵參與支持團體活動減輕其無望感。經由提供上述個別化護理照護，協助個案在轉換不同透析治療模式時可順利適應新生活型態。 <>This paper is to explore the nursing experience of the physical and psychological health impacts and difficult adaptation in a 60-year-old woman who changed different dialysis treatments in her end-stage of renal disease. Gordon’s 11 health function patterns were applied to assess the case from January 6th to December 31st, 2020. The main nursing problems of the case were excessive body fluid volume, anxiety, and hopelessness. The relevant nursing interventions were used to make the case understand the importance of the excess body fluid volume, control of diet, and water to lower edema. In order to reduce anxiety caused by punctures, the nursing care was to schedule the individual puncture plan and the treatment of local anesthetic ointment. We listened to her uneasiness, adjusted the dialysis arrangement, and encourage her to participate in the support group to reduce her hopelessness. By providing the above-individualized care, the patient successfully adapts to the new lifestyle in switching to different dialysis treatment modes.<>
{"title":"照顧一位末期腎病患者轉換透析治療模式適應過程之護理經驗","authors":"何育菁 何育菁, 李麗君 李麗君","doi":"10.53106/172674042023122201001","DOIUrl":"https://doi.org/10.53106/172674042023122201001","url":null,"abstract":"本文為探討一位60歲女性末期腎病患者，在轉換不同透析治療模式時造成生理與心理的健康衝擊及適應困難之護理經驗。筆者於2020年1月6日至12月31日照護期間利用Gorden 十一項健康功能型態進行評估。確認個案主要護理問題為體液容積過量、焦慮和無望感。藉由相關護理指導使個案了解體液容積過量與飲食、水份的控制對改善水腫的重要性；提供個別性護理與個案共同規劃穿刺計畫、配合局部麻醉藥膏使用，降低因為穿刺引起之焦慮；傾聽個案不安，協助調整透析安排、鼓勵參與支持團體活動減輕其無望感。經由提供上述個別化護理照護，協助個案在轉換不同透析治療模式時可順利適應新生活型態。 <>This paper is to explore the nursing experience of the physical and psychological health impacts and difficult adaptation in a 60-year-old woman who changed different dialysis treatments in her end-stage of renal disease. Gordon’s 11 health function patterns were applied to assess the case from January 6th to December 31st, 2020. The main nursing problems of the case were excessive body fluid volume, anxiety, and hopelessness. The relevant nursing interventions were used to make the case understand the importance of the excess body fluid volume, control of diet, and water to lower edema. In order to reduce anxiety caused by punctures, the nursing care was to schedule the individual puncture plan and the treatment of local anesthetic ointment. We listened to her uneasiness, adjusted the dialysis arrangement, and encourage her to participate in the support group to reduce her hopelessness. By providing the above-individualized care, the patient successfully adapts to the new lifestyle in switching to different dialysis treatment modes.<>","PeriodicalId":509550,"journal":{"name":"臺灣腎臟護理學會雜誌","volume":"19 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.53106/172674042023122201005
張懷萱 張懷萱, 孫婉娜 孫婉娜
本文描述照顧一位長期血液透析的青壯年男性，因多次癌症復發加上標靶藥物治療下，出現多重副作用而面臨減藥及停藥困境，使個案擔憂癌症治療成效，及對未來生活的不可控制下，不斷出現負向談話引發筆者關注。護理期間自2021年01月04日至02月26日，筆者運用生理、心理、社會及靈性層面進行整體性評估，並透過觀察、病歷查閱、身體評估及會談收集資料，確立個案有「潛在危險性出血」、「腹瀉」及「無望感」之健康問題。筆者藉由個案血液透析治療期間，給予主動關懷，運用傾聽及肢體語言方式，增加個案信任感，並從中了解個案生活習慣；對疾病、未來生活的疑慮與不安感受，個別進行澄清並媒合醫療成員及病友團體等，以增強個案對疾病治療認知，尋找不一樣的生命意義；降低個案腹瀉及潛在危險性出血相關問題，以增進個案對疾病自我生活注意事項及生活掌控度。建議針對該類病人在門診追蹤時，可增加心理層面評估，透過專科醫師檢視下及早發現病人是否有情緒困擾問題。 This article describes the care of a young adult male long-term hemodialysis patient. The patient was concerned about the efficacy of cancer treatment due to multiple side effects after multiple cancer recurrences and target drug therapy, which resulted in dose reduction and drug discontinuation. In addition, the patient also had a problem of facing the uncontrollable future of life and his continuous pessimistic attitude attracted the author’s attention. From January 04 to February 26, 2021, the author conducted a comprehensive assessment of the physiological, psychological, social and spiritual aspects, and employed through observation, medical history review, physical evaluation and interview, to confirm that the patient had “potential risk of bleeding”, “diarrhea” and “sense of hopelessness”. During the period of hemodialysis, the author actively cared for the patient, used listening and body language to increase the trust of the patient, and learned the lifestyle habits of the patient, clarify the doubts and uneasiness about the disease and the future life of the patient and coordinated with medical team members and patient groups, to enhance the patient’s understanding of the treatment of the disease and search for the different meaning of life. This reduced diarrhea and potential bleeding-related problems, which enhanced the self-awareness and control of the disease by the patient. It is suggested that psychological assessment should be added to the outpatient follow-up, so as to promptly determine whether patients have emotional distress through specialist examination.
{"title":"照顧一位血液透析多次腎癌復發青壯年病人之護理經驗","authors":"張懷萱 張懷萱, 孫婉娜 孫婉娜","doi":"10.53106/172674042023122201005","DOIUrl":"https://doi.org/10.53106/172674042023122201005","url":null,"abstract":"本文描述照顧一位長期血液透析的青壯年男性，因多次癌症復發加上標靶藥物治療下，出現多重副作用而面臨減藥及停藥困境，使個案擔憂癌症治療成效，及對未來生活的不可控制下，不斷出現負向談話引發筆者關注。護理期間自2021年01月04日至02月26日，筆者運用生理、心理、社會及靈性層面進行整體性評估，並透過觀察、病歷查閱、身體評估及會談收集資料，確立個案有「潛在危險性出血」、「腹瀉」及「無望感」之健康問題。筆者藉由個案血液透析治療期間，給予主動關懷，運用傾聽及肢體語言方式，增加個案信任感，並從中了解個案生活習慣；對疾病、未來生活的疑慮與不安感受，個別進行澄清並媒合醫療成員及病友團體等，以增強個案對疾病治療認知，尋找不一樣的生命意義；降低個案腹瀉及潛在危險性出血相關問題，以增進個案對疾病自我生活注意事項及生活掌控度。建議針對該類病人在門診追蹤時，可增加心理層面評估，透過專科醫師檢視下及早發現病人是否有情緒困擾問題。 This article describes the care of a young adult male long-term hemodialysis patient. The patient was concerned about the efficacy of cancer treatment due to multiple side effects after multiple cancer recurrences and target drug therapy, which resulted in dose reduction and drug discontinuation. In addition, the patient also had a problem of facing the uncontrollable future of life and his continuous pessimistic attitude attracted the author’s attention. From January 04 to February 26, 2021, the author conducted a comprehensive assessment of the physiological, psychological, social and spiritual aspects, and employed through observation, medical history review, physical evaluation and interview, to confirm that the patient had “potential risk of bleeding”, “diarrhea” and “sense of hopelessness”. During the period of hemodialysis, the author actively cared for the patient, used listening and body language to increase the trust of the patient, and learned the lifestyle habits of the patient, clarify the doubts and uneasiness about the disease and the future life of the patient and coordinated with medical team members and patient groups, to enhance the patient’s understanding of the treatment of the disease and search for the different meaning of life. This reduced diarrhea and potential bleeding-related problems, which enhanced the self-awareness and control of the disease by the patient. It is suggested that psychological assessment should be added to the outpatient follow-up, so as to promptly determine whether patients have emotional distress through specialist examination.","PeriodicalId":509550,"journal":{"name":"臺灣腎臟護理學會雜誌","volume":"65 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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