頁籤選單縮合
題名 | 九十三歲高齡透析患者安寧緩和之護理經驗=Nursing Experience of a 93-Year-Old Dialysis Patient in Hospice and Palliative Care |
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作者 | 李欣芳; 張元玫; Li, Hsing-fang; Chang, Yuan-may; |
期刊 | 健康與建築雜誌 |
出版日期 | 20150200 |
卷期 | 2:1 2015.02[民104.02] |
頁次 | 頁74-82 |
分類號 | 419.77 |
語文 | chi |
關鍵詞 | 高齡透析; 居家安寧緩和; 善終; Senior person dialysis; Hospice and palliative home care; Good death; |
中文摘要 | 一位93歲高齡透析患者左膝下截肢,右手自體動靜脈廔管功能不佳,多次重複放置永久性雙迴路透析導管效果不佳,引起個案情緒低落,決定不透析,經過個案與家屬討論後,協助轉居家安寧面對死亡,經筆者的個別性護理措施,協助個案轉居家安寧後面對死亡、交代遺願、討論後事與善終,護理期間103年08月18日~103年09月15日,運用觀察、會談、關懷、傾聽技巧,運用羅氏適應模式評估歸納個案護理問題有:1.身體心像完整性缺失/善終前左膝下截肢2.預期性哀傷/拒絕治療後面對死亡3.臨終前舒適。護理過程藉由文獻查證,針對身體心像完整性缺失及預期性哀傷,提供疾病照護相關資訊及往生後有全屍之方法,並引導家屬緩解面臨死亡的哀傷及恐懼,表達安寧死亡之醫療決策所帶來的罪惡感,運用安寧療護理念,針對個案臨終前舒適,提供個案及家屬情緒支持、陪伴及不透析後注意事項,並衛教家屬瀕死照顧技能與舒適護理,使個案得以安詳善終,完成個案遺願。 |
英文摘要 | A 93-year-old dialysis patient suffered from peripheral arterial occlusive and finally underwent a left transtibial amputation. The native arteriovenous fistulas (AVF) of patient's right arm did not function very well, so the permanent catheter (Permcath) had been reimplanted several times. All of these caused patient's negative emotions and she decided to forgo dialysis. After discussing with family, the patient's decision had been respected; we therefore transferred the patient to hospice home care. The author applied individual nursing intervention to help patient and her family to face death, state last wishes and arrange the funeral and a good death. During the nursing period from August 18th to September 15th 2014, the author used observational, communication, caring, listening skills, and combine with Roy's adaptation model to define this case problems: 1. Body image disturbance due to the left transtibial amputation. 2. Anticipatory grief related to the fact of facing death after giving up dialysis. 3. The comfort of patient at the end of life. In the process of nursing this patient, the author did a literature review to help the patient and her family to overcome those problems. By offering care information and service of keeping the cadaver intact, we reduced the body image disturbance. For anticipatory grief, we believed to help the family to express their feeling of guilty caused by this decision. Emotional supporting and accompanying were also provided in order to assist the family in taking care of the near-death patient and alleviating the patient's physical discomfort. In the end, the patient had a good death and the family was relieved by accomplishing her will. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。