本文探討一位高血壓患者因未遵從醫囑按時服用降血壓藥，而導致慢性腎實質病變需長期接受透析治療。筆者自2013年6月10日至2013年8月7日，依生理、心理、社會及靈性四大層面進行評估，確立患者有營養少於身體需要、知識缺失、抉擇衝突等健康問題。護理期間教導高生物價蛋白質食物的認知及營養攝取，減少罹病率及死亡率；指導動靜脈瘻管照護知識並積極尋找戒菸治療，使患者擁有一條良好且通暢的血管通路，以利透析的進行及良好的透析品質；傾聽內心的感受及需求、提供充足透析資訊，澄清錯誤訊息，減少患者在抉擇治療上產生的困擾，選擇適合自己的透析方式，增加自我照顧能力，進而可以勇敢面對未來的生活。

This case report describes the experience of providing nursing care to a patient during his decision-making in selecting a type of dialysis treatment. Care was provided from June 10 to August 7, 2013. The physiological, psychological, social, and spiritual aspects were used to assess the patient’s health problems, and relevant data were collected by conducting physical examination, observations, and interviews. We found that the patient experienced nutrition less than body requirement, knowledge deficit, and decisional conflicts. The nursing care process included collaborating with dieticians to develop a high quality dietary model to decrease malnutrition risks, teaching arteriovenous fistula care skills to prevent complications, and providing information, sharing experiences, and introducing the hemodialysis process to mitigate the decisional conflicts experienced by the patient. By employing these strategies, nurses could provide the support the patient to possess a high quality life. The results of this report can serve as a reference for nursing staff, and may assist nurses with providing care for similar patients in the future.