76 Willams, Sawyer, Roseman, & Allman, Kugler, Maeding, & Russell, Yokoyama ml Russell et al., 2

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1 75 * ** Harwood, Wilson, Cusolito, Sontrop, & Spittal, 2009 * ** (03) yuchu@mail.ypu.edu.tw DOI /

2 76 Willams, Sawyer, Roseman, & Allman, Kugler, Maeding, & Russell, Yokoyama ml Russell et al., Dinwiddie & Bhola, 2010 Harwood et al., Wang Chiou

3 Willams et al., 2008 Kowalski & Bondmass, Minton & Barron,

4 Adalat OROS 1# QD Allopurinal 1# QD Vatatin FC 0.5# HS /80 90 mmhg Creatinine 2.1 mg/dl 4.6 mg/dl Creatinine 8.44 mg/dl K 6.4 mmol/l) Creatinine mg/dl 6 25 hickman /75 88 mmhg kg/m , , Hb 11.7 g/dl Albumin 3.2 g/dl 6 27 WBC 7,500 cumm CRP 1.53 mg/dl /3 1/ BUN 129 mg/dl Creatinine mg/dl Creatinine 5.22 mg/dl

5 79 Xanax 0.5 mg Paramol 1# TID X K 3.5 mmol/dl P 5.7 mmol/dl Carbonate 500 mg 1# TID 1, mg/dl 6 24 HbA1C

6 / S1: 6/28 S2: 6/28 S3: 6/28 S4: 6/28 S5: 6/28 O1: 6/25 Creatinine: mg/dl O2: 6/25 O3: 6/28~7/1 1,200 O4: 6/ O5: 1. 6/ / /

7 / /28 Creatinine > 8 mg/dl / / / / /28 1, / / / / B / /

8 / /5 1 8/5 1. 6/ / /28 7/ /1 4. 7/5 8/ S1: 6/26 S2: 6/26 S3: 6/26 O1: 6/26 O2: 6/25 O3: 1. 6/ /

9 / / / / / / / /5 1. 6/27 2 6/25 6/26 6/28 6/ / /30 S1: S2:

10 84 S3: S4: 40 O1: 6 30 O2: O3: /2 2. 7/ / / / / /1 13:00 14: / / / / / / /

11 /5 1 8/5 1. 7/2 2. 7/5 7/2 8/5 7/2 8/ Wang Chiou 2011 Harwood 2009 Lee

12 DM/DM2_ p01.aspx Dinwiddie, L. C., & Bhola, C. (2010). Hemodialysis catheter care: Current recommendations for nursing practice in North America. Nephrology Nursing Journal, 37(5), Harwood, L., Wilson, B., Cusolito, H., Sontrop, J., & Spittal, J. (2009). Stressors and coping in individuals with chronic kidney disease. Nephrology Nursing Journal, 36(3), Kowalski, S. D., & Bondmass, M. D. (2008). Physiological and psychological symptoms of grief in widows. Research in Nursing & Health, 31, Kugler, C., Maeding, I., & Russell, C. L. (2011). Non-adherence in patients on chronic hemodialysis: An international comparison study. Journal of Nephrology, 24(3), doi: /JN Lee, A., Gudex, C., Povlsen, J. V., Bonnevie, B., & Nielsen, C. P. (2008). Patients views regarding choice of dialysis modality. Nephrology Dialysis Transplantation, 23, doi: /ndt/gfn365. Minton, M. E., & Barron, C. R. (2008). Spousal bereavement assessment a review of bereavement-specific measures. Journal of Gerontological Nursing, 34(8), Russell, C. L., Cronk, N. J., Herron, M., Knowles, N., Matteson, M. L., Peace, L., & Ponferrada, L. (2011). Motivational interviewing in dialysis adherence study. Nephrology Nursing Journal, 38(3), Wang, L. M., & Chiou, C. P. (2011). Effectiveness of interactive multimedia CD on self-care and powerlessness in hemodialysis

87 patients. Journal of Nursing Research, 19 (2), 102-110. doi: 10.1097/ JNR.0b013e31821b0eff. Willams, B. R., Sawyer, P., Roseman, J. M., & Allman, R. M. (2008).

13 87 patients. Journal of Nursing Research, 19 (2), doi: / JNR.0b013e31821b0eff. Willams, B. R., Sawyer, P., Roseman, J. M., & Allman, R. M. (2008). Marital status and health: Exploring pre-widowhood. Journal of Palliative Medicine, 11 (6), doi: /jpm 中華民國 102 年 9 月 Yokoyama, Y., Suzukamo. Y., Hotta, O., Yamazaki, S., Kawaguchi, T., Hasegawa, T.,... Fukuhara, S. (2009). Dialysis staff encouragement and fluid control adherence in patients on hemodialysis. Nephrology Nursing Journal, 36 (3), 臺灣腎臟護理學會雜誌第 12 卷第 3 期

14 88 Nursing experience with first-time hemodialysis patient experiencing treatment plan knowledge deficit, powerlessness and grief Shu- Hua Hsu Suh-Mian Wu * Yu-Chu Chung ** Abstract This case report describes the nursing experience with a patient with from chronic renal failure undergoing hemodialysis for the first time powerlessness that experienced treatment plan knowledge deficit, powerlessness and grief. During the nursing period from June 26 to July 2nd in 2010, the author used observations, interviews, physical examinations and review of medical records to identify nursing issues in the five key dimensions: body, emotion, intellect, society and spirituality. Major nursing problems identified included: treatment plan knowledge deficit, powerlessness, and grief. The application of individual nursing intervention during the nursing process educated the patient and her family on self-care of dialysis and dialysis catheter as well as proper diets for kidney disease. We encouraged the patient to learn skills that helped with caring for her disease and self-control in order to adapt to a new life with hemodialysis. At the same time, the author utilized active caring, listening and empathy to provide psychological support and encouragement to the patient and her family. The author also helped the patient cope with the grieving process after the loss of a loved one. The nursing experienced provided in this report should help nursing personnel with similar cases. Key words: hemodialysis, powerless, grief RN, Medical Ward, National Yang-Ming University Hospital RN, MSN, Lecturer, School of Nursing, Yuanpei University* RN, PhD, Associate Professor, School of Nursing, Yuanpei University** Received: Feb. 16, 2012 Revised: Jun. 6, 2012 Accepted for publication: Jun. 20, 2012 Correspondence: Yu-Chu Chung, No. 306, Yuanpei Street, Hsinchu City 30015, Taiwan (ROC), School of Nursing, Yuanpei University Telephone: (03) ext yuchu@mail.ypu.edu.tw DOI: /

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