Nilsson L G, Anderberg C, Ipsen R, Persson E, Andersson G
Gambro AB, Lund, Sweden.
EDTNA ERCA J. 1998 Oct-Dec;24(4):11-4.
A patient approaching the final stage of his renal disease is faced with many difficult questions. Should he opt for a transplant or start on dialysis? In the case of dialysis, can he manage his treatment at home or will he need to be cared for in a clinic? Should be choose peritoneal dialysis or haemodialysis? Is the freedom of being independent from a machine, given by CAPD, as valuable as the freedom of having days without treatment, given by HD? The issues are complex and do not have a given answer. To make the proper decisions about his treatment the patient needs extensive information and support from the caregivers. Likewise, the caregivers need to know the patient well in order to give appropriate advice. In this exchange of information, the renal nurse has a very important role. Some patients may need to be dialysed in a hospital but most can get an equally good or even better dialysis treatment in a less stressful environment. A high degree of self-care is preferred by people who value independence and freedom of movement. Self-care also improves the self-confidence and increases the chances of maintaining employment and a rich social life. Self-care could mean both PD and HD, sometimes with the assistance of a spouse or a nurse. But a certain degree of self-care can also be maintained in limited-care centres and satellites, where the presence of nursing staff gives the feeling of security. For everybody involved, not least the purchasers of health care, it is desirable to keep the patients out of the costly hospital environment for as long as possible.
一位肾病已接近终末期的患者面临着许多难题。他应该选择移植还是开始透析？如果选择透析，他能在家自行治疗还是需要在诊所接受护理？他应该选择腹膜透析还是血液透析？持续性非卧床腹膜透析（CAPD）所带来的摆脱机器束缚的自由，与血液透析（HD）所带来的无需治疗的日子的自由，哪一个更有价值？这些问题很复杂，没有既定答案。为了对自己的治疗做出恰当决策，患者需要从护理人员那里获得广泛的信息和支持。同样，护理人员也需要充分了解患者，以便给出合适的建议。在这种信息交流中，肾脏科护士起着非常重要的作用。有些患者可能需要在医院进行透析，但大多数患者在压力较小的环境中也能获得同样良好甚至更好的透析治疗。重视独立和行动自由的人更倾向于高度的自我护理。自我护理还能增强自信心，增加维持工作和丰富社交生活的机会。自我护理既可以指腹膜透析也可以指血液透析，有时需要配偶或护士的协助。但在有限护理中心和卫星机构也能维持一定程度的自我护理，在这些地方有护理人员在场会让人有安全感。对于每个相关人员，尤其是医疗保健的购买者来说，尽可能让患者远离昂贵的医院环境是很有必要的。
