運用Swanson關懷理論照護一位初次罹患直腸癌個案術後之護理經驗

Nursing Experience from Applying Swanson's Caring Theory to a Patient with Postoperative Rectal Cancer

10.29494/LN.202212_23(4).0009

林虹妙(Hung-Miao Lin)；呂麗戎(Li-Jung Lu)

Swanson關懷理論 ； 直腸癌 ； 腸造口 ； Swanson's caring theory ； rectal cancer ； colostomy

領導護理

23卷4期（2022 / 12 / 01）

131 - 146

繁體中文

本篇個案敘述一名退役軍官對於術後腸造口留存感到羞愧（regretful－遺憾），面對日後腸造口照護表現出焦慮及逃避，故引發筆者深入探討之動機，照護期間為2019年5月11日到5月20日，藉由直接照護、觀察、深度訪談等，以Gordon十一項功能性健康評估收集資料，確立病人有急性疼痛、自我照顧能力缺失、身體心像紊亂等健康問題。照護期間發現病人不願主動學習腸造口照護，照護初期衛教過程頻頻受阻，故運用Swanson關懷理論協助「了解」、「為他做某事」、「在旁陪伴」、「使他能夠」、「維持信念」五大個過程，依照病人個別性提供護理措施，包括提供疾病相關知識，解決病人照護疑慮，教導按摩、放鬆技巧緩解疼痛不適，當病人心情低落適時給予正向鼓勵支持與陪伴，加強病人自我照顧意願，協助度過疾病過程。病人出院返家後已能熟悉腸造口自我照護且恢復以往生活。照護過程中發現衛教成效將影響病人自我照護意願，建議單位可安排腸造口在職教育及實務操作訓練計畫，將單位特性衛教資料資訊化，再依病人個別性補充腸造口照護知識以確保衛教品質，藉由與病人衛教互動，讓病人感受到視病猶親且願意接納而不害怕腸造口照護，得以回歸正常生活。

This study describes a retired military officer who felt shameful and regretful about the retention of the colostomy after surgery, and showed anxiety and evasion towards future colostomy care, which triggered the author's in-depth discussion. The nursing care period was from May 11th to 20th, 2019. Through the direct care, observation, in-depth interviews, and applied ＂Gordon 11 Function Health Patterns Assessment Guide＂, we established the patient's issues included acute wound pain, lack of self-care ability, physical and mental image disorder and other health problems. During the nursing period, it was found that the patient was unwilling to take the initiative to learn colostomy care, and the health education process in the early stage of nursing was frequently obstructed. Hence we utilized Swanson's Caring Theory to help him, the five caring processes include: ＂understanding＂, ＂doing something for him＂, ＂accompanying him＂, ＂enabling him＂, and ＂maintaining belief＂; provides nursing measures according to the patient's individuality, including disease-related knowledge and solving the patient's care concerns; teach massage and relaxation techniques to relieve pain and discomfort, provide positive encouragement, support and companionship when the patient is in a gloomy mood, reinforce the patient's willingness to take care of himself, and assist during the process of disease. After the patient was discharged to return home, he was familiar with colostomy self-care and resumed his normal life. It was found that the effectiveness of health education will impact the patient's willingness to care for oneself. Thus, it is recommended for the nursing department to arrange colostomy on-job education and practical training programs informative the unit-specific health education data, and supplement the knowledge of colostomy care according to the individual patient to ensure the quality of health education. In this way, the patient feels familiar to the disease and is willing to accept the colostomy care without fear.

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