運用跨領域團隊照護一位初次罹患直腸癌個案之護理經驗

Nursing Experience of a Newly Diagnosed Patient with Colorectal Cancer by Interprofessional Team

10.6386/CGN.202003_31(1).0009

田謹翠(Chin-Tsui Tien)；柯幸芳(Hsing-Fang Ko)

直腸癌 ； 結腸造口 ； 身體心像紊亂 ； 無望感 ； Colorectal Cancer ； Colostomy ； body image disturbance ； hopelessness

長庚護理

31卷1期（2020 / 03 / 01）

100 - 111

繁體中文

癌症病人術後不僅面臨疼痛問題，因身體外觀改變，產生負面感受，導致生理及心理層面受到衝擊。本文敘述一位63歲男性個案，因腹痛及解血便一年，在家屬的勸導下就醫，於手術中發現腫瘤侵犯輸尿管及膀胱，接受直腸腫瘤切除合併永久性腸造口及膀胱造口，個案術後無法面對罹癌疾病嚴重，產生情緒低落及對未來沒有希望等情緒。筆者於2017年9月15日至9月27日護理期間，運用傾聽、溝通、觀察、會談及Gordon十一項功能性健康形態進行評估及相關資料收集，確立主要健康問題：急性疼痛、身體心像紊亂及無望感。護理過程中，生理方面除了使用藥物控制疼痛之外，運用精油穴位按摩技巧，轉移及降低病人的疼痛問題；心理方面運用陪伴與家屬的支持，加入跨領域團隊照護資源，提供個案臨床相同的案例，給予關懷及鼓勵，進而使個案能接受造口為身體的一部分，修正其負面的想法，使病人獲得多方面的照護，恢復自信心，以利出院後維持良好生活品質。

Patients with cancer face not only pain but also impacts on the body and spirit aspects due to the change of body appearance to experience negative feelings. This article described the nursing experience of caring a 63 years old male with stage III colorectal cancer. The patient presented with symptoms of abdominal pain and bloody stool passage for one year. He did not receive treatment until persuaded by his family members. Tumor invasion sites included ureter and bladder. He received intra-abdominal cancer excision, permanent colostomy, and cystostomy. The patient experienced negative feelings such as depression and hopelessness because he could not face the serious conditions of cancer and was worried about the unusual judgment of others after surgery. During the period of nursing care between September 15 and 27, 2017, the author used listening, communication, observation, interview, and Gordon 11 function health patterns analysis to identify the nursing problems. The results showed that the patient had anxiety problem before operation. The main nursing problems included acute pain, body image disturbance, and hopelessness. During the nursing process, both pharmacological pain controllers and essential oil massage were used to relieve pain. Good relationship between the patient and the nursing staff was built via accompanying and showing concerns and support for his family members. Moreover, care from interprofessional team was offered. The patient accepted his body appearance, adapted illness status, performed effective self-care for cystostomy, and finally turned negative attitude to positive. Interprofessional Practice (IPP) resource was offered to restore his self-confidence and successfully returned home to maintain good quality of life.

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