協助一位血液透析病人照顧失能配偶之護理經驗

Abstract

本文探討一位血液透析個案，面臨配偶重症失能又肩負照護責任，所引發生、心理及社會問題，護理期間為2019年1月23日至2019年4月15日，依四大層面進行整體性護理評估，經由行為觀察、會談，身體評估及病歷查閱等方式收集資料，歸納出個案有恐懼、營養狀況改變、照顧者緊張等護理問題。傾聽個案的不安與恐懼，引導個案求助於自身信仰達到心靈的安適，並同理不遵守足量透析之決定，評估家庭關係，鼓勵家人參與照護，醫療端配合調整透析時段及地點轉換，讓透析治療不再是一種無法變動的限制，進而改善其飲食及透析狀況，提升透析品質，並連結跨部門及社會團體提供協助，調整生活作息，減緩照顧壓力與緊張，讓個案勝任角色改變之衝擊。  This article investigated the related mental, physiological and social issues of a dialysis patient who bears the responsibility for taking care of a disabled spouse. The nursing care period of the subject was from January 23 to April 15 of 2019. Nursing assessment was performed according to the four dimensions of patient status; data collection was conducted through behavior observations, interviews, physiological evaluation and medical record review. The results showed that the subject was suffering with issues like fear, change in nutrition status and caregiver stress. To assist the subject, we first listened to the fear and anxiety expressed by the subject and then guided the subject to seek spiritual comfort through personal faith. We empathized with the subject’s decision to not adhere to dialysis adequacy and evaluated the subject’s family relationship to identify causes and encourage participation of family members in the care process. On the medical service side, we adjusted the dialysis time periods and changed locations to allow flexibility in dialysis treatment; we then gradually improved the diets of the subject and dialysis conditions to increase the quality of the dialysis. Finally, we worked closely between departments and social welfare societies to provide necessary assistance and adjusted the living habits of the subject to reduce the stress and anxiety related to caregiving, allowing the subject to adjust to the impact of role change.