照顧一位直腸癌個案接受永久性腸造瘻口之護理經驗

The Nursing Experience for a Colorectal Cancer Patient with a Permanent Colostomy

10.3966/102673012017032801009

林慧珊(Hui-Shan Lin)；巫菲翎(Fei-Ling Wu)

大腸直腸癌 ； 結腸造瘻 ； colorectal cancer ； colostomy

長庚護理

28卷1期（2017 / 03 / 01）

100 - 109

繁體中文

本文描述一位直腸癌個案接受永久性腸造瘻口術後之照護經驗，護理期間為2014年3月5日至3月24日，筆者運用Gordon十一項功能性健康型態為評估工具，藉由觀察、會談及身體評估等技巧，收集個案之相關資料分析後，確認個案健康問題包括：急性疼痛、身體心像紊亂及知識缺失。在護理過程中，協助個案與家屬接受腸造瘻口，學會腸造口相關的自我照護，並扮演傾聽、支持及諮詢的角色，引導其訴說擔心與害怕，重新調適身體心像改變的衝擊，進而讓個案願意學習腸造瘻口自我照護相關知識與自我照顧技巧。此次護理經驗以病人為中心，除了考量其身、心、靈需求，並透過病友提供關懷與分享，引導個案主動述說感受及增進家庭成員的照護技巧，能協助類似個案面對身體心像的改變及造瘻口衝擊，重建自信回歸家庭，擁有正常生活之經驗分享。

This article described the nursing care provided to a colorectal cancer patient following permanent colostomy surgery. The care period was between March 5 and 24, 2014. The Gordon function health assessment guide was used to assess the nursing problems. The author employed several approaches of observation, conversation, and physical examination to collect and analyze the clinical data of the patient. Consequently, the author attributed the patient's health problems to acute pain, body image disturbance, and lack of knowledge. During the nursing process, the author assisted the patient and the patient's family members in understanding colostomy and educated them relevant self-care techniques. In addition, the author assumed the roles of a listener, supporter, and advisor to encourage the patient to express her worries and fears and to assist her in adjusting to the changes in body image, thereby increasing her willingness to learn relevant self-care knowledge and techniques. The patient-centered nursing approach adopted by the author accounted for the physical, mental, and spiritual demands of the patient, actively relieved concerns of the patient, increased the patient's willingness to express her feelings, and improved the care skills of the patient's family members. The author concluded that the proposed nursing approach is beneficial for helping similar patients accept their body image, reestablish confidence, and return to their families and everyday lives as well as for reducing the impact of stoma surgery.

1. Burch, J.(2011).Management of stoma complications.Nursing Times,107(45),17-20.
2. Cassidy, J.,Clarke, S.,Díaz-Rubio, E.,Scheithauer, W.,Figer, A.,Wong, R.,Saltz, L.(2008).Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer.Journal of Clinical Oncology,26(12),2006-2012.
3. Gibbons, T.(Ed.)(2013).Nursing diagnosis application to clinical practice.New York:Lippincott.
4. Perston, Y.(2010).Ensuring effective technique in colostomy irrigation to improve quality of life.Gastrointestinal Nursing,8(4),18-22.
5. Yildirim, Y. K.,Cicek, F.,Uyar, M.(2009).Effects of pain education program on pain intensity, pain treatment satisfaction, and barriers in Turkish cancer patients.Pain Management Nursing,10(4),220-228.
6. 行政院衛生福利部(2014)．民國102 年主要死因分析．取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=5012 [Ministry of Health and Welfare, Taiwan, ROC. (2014). 2013 Statistics of causes of death. Retrieved from http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=5012]
7. 張淑芳、許紫燕(2011)。照護一位直腸癌病患接受永久性腸造口之護理經驗。安泰醫護雜誌，17(3)，65-78。
8. 張瓈方、張乃文、王桂芸(2010)。身體心像紊亂之概念分析。長庚護理，21(1)，25-32。
9. 黃家麗、唐秀燕(2011)。一位腸造口術後患者面對身體心像紊亂之護理經驗。嘉基護理，11(2)，48-58。
10. 楊秋萍、莊阿月(2009)。一位行永久性結腸造口術個案之手術全期護理經驗。腫瘤護理雜誌，9(2)，75-87。
11. 鄒芳榆(2013)。照顧一位直腸癌病人接受永久性腸造瘻口的護理經驗。榮總護理，30(4)，425-433。
12. 廖張京棣校閱(2009)。最新實用內外科護理學。台北市=Taipei City, Taiwan, ROC:永大=Yeongda。
13. 劉雪娥校閱(2012)。成人內外科護理學。台北市=Taipei City, Taiwan, ROC:華杏=Farseeing。

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5. 鄭雅方,劉錦蓉,洪怡蘋(2022)。運用通訊軟體照顧一位直腸癌病人適應腸造口之個案管理經驗。腫瘤護理雜誌，22(1)，35-45。