本文是描述一位末期腎病變患者，面對血液透析治療時生理、心理衝擊之護理經 驗。照護期間為 2016 年 1 月 4 日至 2016 年 2 月 24 日，筆者藉由身體評估、行為 觀察、會談技巧及病歷查閱等方式收集資料，並運用 Gordon 十一項功能性健康型態 進行評估，了解個案在接受血液透析治療後所產生身、心理的衝擊，因未做好心理調 適及飲食、水份自我控制能力差，而對人生的未來感到焦慮、無助而出現無望感，經 評估確立個案具有體液容積過量、知識缺失：高血磷及無望感等三項護理健康問題。 筆者在照護過程中利用傾聽、陪伴，與個案建立良好的護病關係，給予支持，並依 個案的個別性提供相關血液透析知識，藉由水份控制、飲食行為指導增加認知，改善 透析治療時所產生的身體不適，期望個案透過護理照護過程更了解疾病歷程與透析治 療相關處置，鼓勵個案參與自我照顧及增強自我控制感，並藉由加強家屬、個案、醫 護團隊三方面支持系統的整合及互動，讓個案能成功適應血液透析治療及改善生活品 質，以達到理想的健康狀態。

The article describes a nursing experience of an ESRD (end-stage renal disease) patient faced with the physical and psychological impact of hemodialysis. The period of nursing care was from January 4 to February 24 in 2016. The author collected data from physical examinations, behavior observation, interviews and review of medical records. Gordon’s 11 functional health patterns assessment was applied to assess the physical and psychological impact of undergoing hemodialysis. The patient felt anxious, hopeless and helpless because of mental maladjustment and failure of diet and fluid controls. The patient's three health problems during nursing care were identified: fluid overload, lack of knowledge about hyperphosphatemia, and hopelessness. During the care period, the author provided the patient with appropriate management through listening, companionship and establishing of the nurse-patient relationship. Mental support hemodialysis knowledge tailored to the patient’s circumstances were also provided. The patient’s discomfort when undergoing hemodialysis was improved after fluid control and instruction in appropriate dietary behaviors. The author hoped that (1) the patient acquired a better understanding of the natural course of ESRD and the associated management; and (2) encouraged the patient to enforce self-care and selfcontrol. By integrating the patient, the family and the care team, the author hoped that the patient can adapt successfully to hemodialysis, to achieve better health and quality of life.