Chiang Yu-Ying, Tsai Li-Ya
BSN, RN, Department of Nursing, China Medical University Hospital, Taiwan, ROC.
PhD, RN, Associate Professor, Post-Baccalaureate Program in Nursing, College of Nursing, Asia University, Taiwan, ROC.
Hu Li Za Zhi. 2021 Apr;68(2):99-106. doi: 10.6224/JN.202104_68(2).13.
This article describes an experience providing nursing care to a patient under hemodialysis with the end-stage renal disease who had developed depression, loathing, and other, negative personal perceptions and gradually gave up on life goals due to hopelessness. The duration of nursing care, from August 23rd through August 29th, 2019, was revisited to identify the patients hopelessness in the dimensions of physiology, mental status, society, and spirituality. The author applied Swansons Caring Theory to facilitate the process of "knowing" and "being with" while performing direct nursing care and attentive listening to assist the patient to become more open-minded and to express personal perceptions toward the disease with the goal of further engaging the patient to increase self-awareness recognition, sense of loss, and negative perceptions. Through "doing for" and "enabling," the author reinforced infection control and identified the symptoms of fluid-overload, moisture, and salinity to raise the patients self-awareness and self-caring techniques and to lower the risk of hospitalization. Meanwhile, by "maintaining the patients belief," accompanied by the encouragement and attention from family members and providing linkages to patient-support communities, the patient was guided to identify and aggregate to foster positive thinking and self-worth to increase acceptance of living with the disease. Nursing personnel may apply Swansons Caring Theory to better consider the patients perspective, provide individual caring schemes, and strengthen the recognition, self-caring techniques and supportive systems of patients, increasing patient perceptions of self-worth, restoring their confidence, promoting their adaption to their disease, and improving attentiveness.
本文描述了为一名患有终末期肾病且正在接受血液透析的患者提供护理的经历，该患者出现了抑郁、厌恶及其他负面的个人认知，并因绝望逐渐放弃了生活目标。回顾了2019年8月23日至8月29日的护理过程，以确定患者在生理、心理状态、社会和精神层面的绝望感。作者应用斯旺森关怀理论，在进行直接护理和专注倾听时，推动“了解”和“陪伴”过程，以帮助患者更加豁达，表达对疾病的个人认知，进而促使患者增强自我认知、失落感和负面认知。通过“为患者做”和“使能”，作者加强了感染控制，识别出液体过载、潮湿和盐分等症状，以提高患者的自我认知和自我护理技能，降低住院风险。同时，通过“维系患者信念”，在家人的鼓励和关注以及与患者支持社区建立联系的陪伴下，引导患者识别并凝聚积极思维和自我价值，以增强对带病生活的接受度。护理人员可应用斯旺森关怀理论，更好地考虑患者的观点，提供个性化关怀方案，强化患者的认知、自我护理技能和支持系统，增强患者的自我价值感，恢复其信心，促进其对疾病的适应，提高关注度。
