Watson Krespi, Bone, Ahmad, Worthington, & Salmon, 2008Eghbali, Shahqolian, Nazari, & Babaee ~ Lindberg, Wikström, & Lindberg,

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1 86 * Watson Roche, 2009 * tyjchen@vghtpe.gov.tw

2 Watson Krespi, Bone, Ahmad, Worthington, & Salmon, 2008Eghbali, Shahqolian, Nazari, & Babaee ~ Lindberg, Wikström, & Lindberg, 2011 Lata1, Albuquerque, Carvalho, & Lira, Mystakidou, Tsilika, Parpa, Galanos, & Vlahos,

3 Honea et al., 2008 Caruso, Cisar, & Pipe, 2008 Watson, 1988 Watson Watson, 2009Watson C C Child-Turcotte-Pugh Class C

4 Watson /86 mmhg 74 / 24~26 / X-ray cardiothoracic Ratio SpO ~2 500 cc/ BMI 18.2 kg/m² gm/dl 3.9 gm/dlblood urea nitrogen, BUN89 mg/dl creatinine, Cr13.8 mg/dl 10 mg/dl4.4 mg/dl 132 mg/dl 70 mg/dl normalized protein catabolic rate PCRn

5 ~2 1~2 500 cc/ ~

6 91 3 / / / / ~ /1 3/22 S 1 S /

7 /20 12/21 S3 2. 1/1 12/11 S / O O2 2 O

8 93 / ~ ~ 12/2 2.1 Kg 1 /29 S1 S2 S3 1~2 500 cc 11/20 S4 O1 130/86 mmhg 74 / 24 / 90/50 mmhg O2 C/T Ratio 49 3 I/O+1,500 O cc / /2 120/76 mmhg 72 / 17 / 12/

9 O4 Albumin 3.9 mg/dl HCT 30.6 gm/dl BUN 89 mg/dl Cr 13.8 mg/dl Na 137 mmol/l SpO2 96 O6 O / O ~2.5 Kg 12/ Kg / Kg 1/

10 95 / ~ /11 2/10 4 /30 S1 11/20 S2 12/14 S3 12/14 S4 1/22 S5 O1 O /11 11/20 12/30 11/22 2/26 7 Yr-90 sirt 3/12 4/

11 96 Watson gov.tw/cht2006/dm/dm2_2. aspx?now_fod_list_no=11962&class_ no=440&level_no=

12 Caruso, E. M., Cisar, N., Pipe, T. (2008). Creating a healing environment: An innovative educational approach for adopting Jean Watson s theory of human caring. Nursing Administration Quarterly, 32(2), Eghbali, M., Shahqolian, N., Nazari, F. & Babaee, S. (2009). Comparing problems of patients with chronic renal failure undergoing hemodialysis and peritoneal dialysis referring to medical university s hospitals. Indian Journal of Medical Research, 14(1), 1-5. Honea, N. j., Brintnall, R., Given, B., Sherwood, P., Colao, D. B., Somers, S. C., & Northouse, L. L. (2009). Putting evidence into practice: Nursing assessment and interventions to reduce family caregiver strain and burden. Clinical Journal of Oncology Nursing, 12(3), Krespi, M. R., Bone, M., Ahmad, M., Worthington, B., & Salmon, B. (2008). Hemodialysis patients evaluation of their lives. Turkisb Journal of Psychiatry, 19(4), 1-7. Lata1, A. G. B., Albuquerque, J. G., Carvalho, L. A. S. B. P., & Lira, A. L. B. C. (2008). Nursing diagnosis in adults on hemodialysis. Acta Paul Enferm, 21(Número Especial) Lindberg, M., Wikström, S. B., & Lindberg, P. (2011). A behavioural nursing intervention for reduced fluid overload in haemodialysis patients. Initial results of acceptability, feasibility and efficacy. Journal of Nursing and Healthcare of Chronic Illness, 3(2), Mystakidou, K., Tsilika, E., Parpa, E., Galanos, A., & Vlahos, L. (2007). Caregivers of advanced cancer patients: Feelings of hopelessness and depression. Cancer Nursing, 30(5), Roche, V. (2009). The hidden patient: Addressing the caregiver. American Journal of the Medical Sciences, 337(3), Watson, J. (1988). Nursing: Human science and human care - a theory of nursing (pp 1-8). New York: National League for Nursing Press. Watson, J. (2009). Caring science and human caring theory: Transforming personal and professional practice of nursing and health care. Journal of Health and Human Services Administration, 31(4),

13 98 Nursing Experience with a Regular Hemodialysis Patient Whose Primary Caregiver Was Unexpectedly Diagnosed with Cancer Tzu-Yin Chen Hsin-Ling Tai Fen-Chu Chen* Abstract This report documented the nursing experience with a regular hemodialysis patient behaving in a negative way because the patient's primary caregiver was unexpectedly diagnosed with liver cancer. Observation and nursing care was lasted from November through to April 30, We analyzed this case and found that she was experiencing hopelessness, excess fluid volume, and caregiver role strain with her primary caregiver. The Jean Watson s theory of transpersonal caring was adopted to manage this patient by encouraging the family to share their feelings. We also used communication skills to affirm and accept the patient s positive and negative feelings as well as relieve physical, psychological and socioeconomic stress. The patient eventually came to terms with role of no longer being the care recipient as well as the fact that that the primary caregiver now had cancer and was able to accept the progression of their respective illnesses. This case report will hopefully provide nursing staff with a better understanding of these patients so appropriate consultation and support can be provided. Key words: regular hemodialysis, primary caregiver, cancer RN, Department of Nursing, Taipei Veterans General Hospital RN, Department of Nursing, Taipei Country Hospital* Received Aug. 15, 2011 Revised Sep. 21, 2011 Accepted for publication Dec. 5, 2011 Correspondence Tzu-Yin Chen, No. 201, Sec. 2, Shih-Pai Rd., Taipei. Telephone tyjchen@vghtpe.gov.tw

67 chronic kidney disease, CKD glomerular filtration rate, GFR 60 ml/1.73 m 2 /min GFR CKD St. Peter, Schoolwerth, McGowan, & McClellan,

67 chronic kidney disease, CKD glomerular filtration rate, GFR 60 ml/1.73 m 2 /min GFR CKD St. Peter, Schoolwerth, McGowan, & McClellan, 66 * chronic kidney disease, CKD 2012 4 12 2012 8 6 2012 63,999 hemodialysis, HD 57,615 90 peritoneal dialysis, PD 6,384 10 2012 2002 * 103 4 23 103 12 23 104 1 15 100 18ES (07) 3121101 5564 wanchun0955@hotmail.com