運用Orem理論照護一位膀胱全切除合併迴腸膀胱造口術後病人之護理經驗

A Postoperative Nursing Experience of a Patient Who Received Radical Cystectomy and Ileocystostomy: An Application of Orem's Theory

10.6142/VGHN.202106_38(2).0010

蔡馥如(Fu-Ru Tsai)；林佳慧(Chia-Huei Lin)

Orem理論 ； 膀胱切除 ； 迴腸膀胱造口 ； 護理 ； Orem's Theory ； radical cystectomy ； ileal conduit ； ileocystostomy

榮總護理

38卷2期（2021 / 06 / 01）

194 - 202

繁體中文

本文乃描述運用Orem自我照護理論照護一位接受膀胱全切除合併迴腸膀胱造口術後病人之護理經驗。護理期間為2018年8月2日至8月15日，筆者藉由身體評估、溝通會談及查閱病歷等方式收集資料，並運用Orem自我照護理論之評估工具確立病人有：「腸胃能動性失常」、「潛在危險性感染」及「身體心像紊亂」等健康問題。筆者整合相關文獻，提供以實證為基礎的個別性護理措施，包括：術後咀嚼口香糖、穴位按摩等方式緩解腸胃不適；邀請病人及家屬共同執行傷口與管路照護，以預防感染；及鼓勵病人漸進式接納身體構造與功能改變之事實，並引介病友分享經驗，改善病人身體心像紊亂問題；同時增強病人自我照顧動機與技巧，以提升返家後的生活品質。期望透過此次經驗提供臨床護理人員照護此類個案之參考。

This article reports our experience in postoperative nursing care; we applied Orem's theory in caring for a patient with bladder cancer who had received a radical cystectomy and ileocystostomy. During the nursing period of August 2 to 15, 2018, the author collected data through physical assessment, interviews, and medical records and applied Orem's theory to evaluate the patient. The author identified three major health problems: dysfunctional gastrointestinal motility, risk of infection, and disturbed body image. The author integrated the findings of various studies to provide evidence-based and individualized care interventions. First, the author offered the use of chewing gum and acupressure treatment to relieve postoperative gastrointestinal discomfort. Second, the patient was encouraged to express his own feelings and accept the changes occurring in his body's structure and function gradually. Third, the author introduced the patient to other patients who shared similar experiences to ease his problems with disturbed body image. Additionally, the author helped improve the patient's motivation and self-care skills to improve his quality of life after discharge. This article is useful for clinicians when they care for similar patients.

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