照顧一位大腸癌病人之護理經驗

Nursing Care for a Patient with Colon Cancer

10.6880/TJON.202012_20(2).05

賴青青(Ching-Ching Lai)；洪淑萍(Shu-Ping Hung)

抉擇困難 ； 疼痛 ； 自我照顧能力缺失 ； difficult choices ； pain ； self-care deficit

腫瘤護理雜誌

20卷2期（2020 / 12 / 01）

35 - 45

繁體中文

本文描述一位罹患大腸癌復發併腸造口術後的病人，護理期間為2017年10月1日至10月20日，藉由直接護理、會談、觀察及身體評估收集資料，運用Gordon十一項健康型態評估，確認病人有抉擇困難、疼痛及自我照顧能力缺失等健康問題，提供個別性的護理措施，包括：運用醫病共享決策的模式，邀請個案及案妻子共同討論執行及不執行手術的優點及缺點，並說明執行與不執行手術所要面臨的問題，鼓勵個案提出討論及說出自己的疑問，包括外觀改變、氣味、後續照護詳細說明，對於個案不清楚的部分再次說明，促使其有決策的信心和能力，成功協助個案做出對自己適合的抉擇；針對疼痛的健康問題，教導非藥物性的輔助方式，包括芳香療法透過指壓按摩合谷穴，深呼吸放鬆技巧，有效減緩其疼痛；住院期間教導個案對於腸造口的自我照顧，提供相關資訊包括影片、模型，逐一講解腸造口放置的必要性、手術過程、術後的樣貌及照護，個案能回覆示教自我照顧技巧進而熟練；藉此照護經驗分享，讓臨床護理人員在面對病人可提供個別性的照護，使每位病人均能提升生活品質。

This article describes the experience of caring for a patient with colorectal cancer recurrence and intestinal surgery. The care period was 1 October to 20 October 2017. Patient data were collected through direct care, talks, observation and body assessment data. Gordon's eleven health-form assessments was used to confirm that the patient had ＂difficulty making decisions,＂ ＂pain＂, and ＂self-care deficit＂. We provided individual care measures, including: the doctor-patient shared decision-making model, discussions between the patient and wife about the advantages and disadvantages of the surgery, and explaining the possible problems and risks associated with surgery or the absent of. We also encouraged patient to discuss and voice his concerns, including changes in appearance, odor, and follow-up care. For the parts the patient was unclear of, the explanation was repeated to help build the patient's confidence and ability to make decisions, and to successfully assist the patient to make his own suitable choices for pain problems and better health. In addition to the instruction on prescription painkillers and dose adjustment based on patient feedback, patient was also taught about other holistic way to address pains, including the use of accu-pressure point massage and deep breathing relaxation techniques for pain control. Before discharge, patient was taught the self-care of ileostomy pocket and valve through the use of videos, models, one-on-one demonstration of the reason for ileostomy, surgery procedures, postoperative appearance and care. Patient responded well to the patient education by exhibiting his self-care skills. We hope this experience sharing can set guidelines for the inpatient nursing staff to provide individualized patient care so that each patient can achieve the goal of improving the quality of life.

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