本文為探討一位末期腎病變患者因面臨腎功能衰竭，初次接受血液透析治療之護理經驗。 筆者於2012年12月17日至2013年1月30日，藉由直接照護、實際觀察、會談、身體評估 及檢驗數據之方式收集資料後，運用羅氏適應模式架構，進行護理評估與分析，確立個案有： 體液容積過量、知識缺失（高血磷）、焦慮、無望感等護理問題。筆者在護理期間透過醫療團隊 合作與討論，協助個案對疾病有正確的認知，適應疾病治療過程，增強自我照顧能力，讓個案 能適當的控制水分攝取、改善體液容積過量；依照個別性評估飲食日誌内容，給予限磷飲食衛 教、藥物指導，使個案減少對高磷食物的攝取、修正降磷藥物服用的觀念，以降低血磷值。經 由主動關懷、傾聽、同理心及接受等技巧與個案建立良好護病關係，鼓勵個案表達意見及内心 想法，澄清個案對血液透析治療的疑慮，以減輕其心中的不安與焦慮，並運用陪伴、鼓勵、以 及來自家人的支持及腎友的經驗分享，協助個案以正向積極的態度來面對血液透析的生活，重 拾對生命的信心與希望。

This study is on the nursing experience of a patient with end-stage renal disease to start hemodialysis therapy due to renal failure. Information was collected by the author from Dec 17, 2012 to Jan 30, 2013 with viadirect care, observations, interviews, physical examinations and laboratory data, followed by analysis with Roy’s adaptation model. The patient was identified with nursing care issues including fluid overload， lack of specific knowledge(hyperphosphatemia)， anxiety， and sense of hopelessness. During the nursing care period, via medical cooperation and discussion，the author assisted the patient in acquiring correct knowledge of the disease, adapting to the therapy, strengthening the self-care capability, such that the patient may have proper control of liquid intake to improve in fluid overload. The author assess individualized of dietary diary to help the patient to reduce serum phosphorous level by providing healthcare education in phosphorous restriction diet, lowering his intake of high-phosphorous food, and correcting his concept of phosphorus-lowering medications. The author adopted the techniques of active care, listening, empathy and acceptance and established a good nurse-patient relationship. With encouragement to express his opinions and feelings, clarification of doubts about hemodialysis therapy, lessening of anxiety and uneasiness, support from family, experience-sharing from other kidney patients, the patient was helped to take a positive and active attitude in facing hemodialysis and regain the confidence and hope in life.