照顧一位乳癌骨轉移病人不遵從服藥之護理經驗

Nursing Experience Regarding a Noncompliant Breast Cancer Patient With Bone Metastasis

10.6142/VGHN.201712_34(4).0010

劉靜芳(Chang-Fang Liu)；陳芝文(Chih-Wen Chen)

乳癌骨轉移病人 ； 不遵從 ； breast cancer patient with bone metastasis ； noncompliant

榮總護理

34卷4期（2017 / 12 / 01）

415 - 423

繁體中文

本篇個案報告旨在描述位39歲的國小老師，因乳癌骨轉移併發疼痛不遵從服藥之護理經驗，護理期間自2015年5月16日至5月26日，藉由身體評估、會談、溝通、傾聽、引導方式進行資料收集，筆者運用Gordon十一項健康評估工具進行個案整體性評估，發現個案有疼痛、服藥不遵從、無望感之健康問題。藉由疼痛評估與醫師討論調整用藥、運用推撫按摩技巧緩解疼痛，透過良好的醫病關係，以不批判的態度傾聽個案對於藥物成癮的看法，讓個案了解持續且規則服用嗎啡藥物達有效的控制疼痛。協助家屬及鼓勵個案表達對疾病與未來的感受，在個案說出缺乏信心的言語時，引導正向思維，增進病人之希望，引導親友說出對個案的正向回饋及讚美，使個案肯定自我價值，重拾希望並發展正向的調適技巧，進而適應疾病的變化並坦然面對未來的生活，建議護理主管及教育單位應加強醫護人員及民眾的疼痛教育訓練，讓止痛藥物能正確的使用，使病人得到更優質的疼痛照護。

This article describes a nursing experience regarding a 39-year-old noncompliant breast cancer patient with bone metastasis. The nursing period lasted from May 16 to 26, 2015. Data were collected through physical examination, observation, and an interview. Gordon's 11 functional health patterns were used for evaluation, revealing that the patient exhibited problems such as pain, noncompliance, and feeling hopeless. The visual analog scale (VAS) was used to evaluate the degree of pain, and massage techniques were introduced to the patient in order to relieve the pain caused by bone metastasis. By listening to the patient's understanding of and opinions concerning drug addiction with a noncritical attitude, we then informed the patient that taking morphine regularly would control the pain effectively. The patient and family members were encouraged to express feelings about the disease and about the future. While the patient expressed doubts or insecurity, support such as empathy, acceptance, and attention was provided, as well as correct and relevant information. Family members were encouraged to express positive feedback and compliments to the patient in order to help the patient perceive improved self-esteem.

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