照顧一位血液透析多年患者遭逢喪失女友之護理經驗

Abstract

本文是探討一位 49 歲血液透析患者已接受透析治療 31 年，近來因遭逢喪失女友 後所引起的心理調適障礙之護理經驗。護理期間由 2016 年 7 月 18 日至 2016 年 9 月 16 日，藉由「羅氏適應模式」為評估工具，運用觀察、會談、身體評估、傾聽、使用 問卷量表及病歷查閱等方式收集主、客觀資料，確立個案有「體液容積過量」「營養 狀況不平衡／少於身體所需」及「調適障礙」等問題，筆者在護理過程中陪伴個案經 歷悲傷過程，主動關懷，運用同理心，傾聽個案感受，給予適當的護理措施，製作飲 食紀錄表和個案共同討論水分控制的注意事項，進而改善體液容積過量及透析中低血 壓的產生，利用迷你營養評估量表（Mini Nutritional Assessment, MNA）評估其營 養狀況，使其了解飲食管理方法而改善營養不良，並引導說出內心的感受與想法，透 過聆聽音樂及宗教信仰的介入，來減輕負向情緒，讓個案重新適應女友不在的環境及 將情感投注在生活上，提升個案自我照顧能力及生活品質。

This article explored the nursing experience of a 49-year-old hemodialysis patient who has undergone dialysis for 31 years and has recently suffered a psychological adjustment disorder due to the loss of his girlfriend. During the nursing period, from July 18, 2016 to September 16, 2016, the “Roy Adaptation Model” was used as the assessment tool to collect the data of the subjects from the observation, talks, physical assessment, listening, objective information, it was established that the patient suffered from “excess fluid volume,” “nutritional imbalance / less than the body needs” and “barriers to adjustment” issues. During the care period, the author accompanied the process of grief, actively showed care, listened to the feelings of the patient, provided appropriate nursing care measures, made food records and discussed water control with case, thereby improving the control of body fluid volume and hypotension due to dialysis, employed the use of Mini Nutritional Assessment (MNA) scale to assess the patient’s nutritional status, understand diet management methods to correct malnutrition, and provided encouragement for him to speak out his feelings and thoughts; used listening to music and religious intervention to alleviate the negative emotions, to enable the patient to adapt to life without his girlfriend, to focus in his life, to improve his ability of self-care and his quality of life.