運用Swanson關懷理論照護一位初診斷乳癌病人之護理經驗

The Nursing Experience of Using Swanson's Caring Theory in a Newly Diagnosed Breast Cancer Patient

10.6880/TJON.202206_22(1).06

林欣蓉(Hsin-Jung Lin)；洪敏瑛(Ming-Ying Hong)；崔宛玉(Wan-Yu Tsui)

Swanson關懷理論 ； 乳癌 ； 個案管理 ； Swanson's caring theory ； breast cancer ； case management

腫瘤護理雜誌

22卷1期（2022 / 06 / 01）

69 - 84

繁體中文

本文敘述一位初診斷乳癌41歲女性，接受乳房手術及術後輔助性化學治療之護理經驗。護理期間為2019年1月30日至10月9日，依生理、心理、社會及靈性進行整體性評估，歸納有焦慮、身體心像紊亂、無效性保護能力等健康問題。初期訪視病人出現哭泣行為，感受到個案面對初診斷癌症對生命造成威脅的徬徨無助，及對手術造成身體心像改變感到焦慮不安，引發筆者深入探討之動機。期望透過Swanson關懷理論，提升個案正向因應能力，引領度過罹癌危機，護理過程中發揮腫瘤個案管理師之角色功能，提供個別性護理措施，診斷期主動關懷個案，建立治療性關係，鼓勵個案表達內心感受，提供疾病相關資訊，減輕病人對疾病及治療的焦慮程度；治療期藉由傾聽、陪伴、引導表達及統整對身體心像改變之感受、鼓勵參與病友團體，使個案能面對及接受身體改變的事實，運用專業知識提供疾病與治療正確訊息、增進化學治療期間自我照顧技巧，追蹤期透過面訪及電話訪視提供持續性照護，協助個案回歸原有的角色功能及提醒定期回診追蹤之重要性。過程中發揮腫瘤個案管理師溝通與協調技巧，提供持續性護理諮詢，整合片段式照護，適時轉介相關資源並將個案狀況回報醫療團隊，協助個案順利調適初罹癌之衝擊並完成治療。此護理經驗期望能提供日後照護類似個案之參考。

This article describes the nursing experience in caring for a 41-year-old woman with newly diagnosed breast cancer treated with mastectomy and postoperative adjuvant chemotherapy. The nursing care was implemented from January 30th, 2019 to October 9th, 2019. The overall assessment in the physiological, psychological, sociological, and spiritual aspects was performed. Three major health problems were identified, including anxiety, body image disturbance, and ineffective protection. The patient cried during the initial visit, revealing her deep sense of helplessness in the face of the life-threatening new diagnosis of breast cancer. Patient also exhibited great anxiety about the changes in body image after the operation. The author was motivated to initiate an in-depth exploration of the patient's experience. It was expected that, with the utilization of Swanson's caring theory, the patient could gain positive coping skills, which could get her through the crisis of having cancer. In the nursing process, the author acted as the oncology case manager to povide individualized caring measures. During the diagnostic period, through proactive care, positive therapeutic relationship, encouragement in the expression of feelings, as well as provision of helpful information, the anxiety of the patient regarding the disease and treatment was reduced. During the treatment period, through listening, companionship, guidance in the expression and integration of feelings about the changes in body image, and encouragement in the participation in patient support group, the patient was able to face and accept the fact of her physical changes. The author utilized professional knowledge to provide correct information on the disease and treatment, as well as improve the patient's self-care skills during chemotherapy. During the follow-up period, the author provided continuous care through in-person and telephone interviews, which helped the patient to regain her original role functions. The importance of regular follow-up visits was also reinforced. During the whole process, communication and coordination skills of an oncology case manager were adopted. Furthermore, continuous nursing consultation was provided and fragmented care was integrated. The patient was referred to relevant resources and her status was reported to the medical team in a timely manner as well. The patient was able to cope with the impact of the cancer diagnosis. She had successfully completed the treatment. It is hoped that this nursing experience could serve as a helpful reference to other nursing staffs in caring for similar patients in the future.

1. 姜亭妤,簡淑慧,徐鴻智,陳淑卿(2018)。心理調節措施在癌症患者身體心像改變及情緒困擾之成效－系統性文獻回顧。長庚護理，29(3)，350-366。
   連結：
2. 施美玲,郭信智,許麗玉(2020)。初診斷乳癌病人術前焦慮之多媒體衛教效果初探。醫務管理期刊，21(1)，13-26。
   連結：
3. 洪曉佩,曾麗華,雍允雯,林素萍,黃瓊慧,明金蓮(2019)。術前焦慮概念分析。榮總護理，36(2)，212-219。
   連結：
4. Cardoso, F.,Kyriakides, S.,Ohno, S.,Penault-Llorca, F.,Poortmans, P.,Poortmans, P.,Rubio, I.T.,Zackrisson, S.,Senkus, E.(2019).Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Annals of Oncology,30(8),1194-1220.
5. Dillon, D.,Guidi, A. J.,Schnitt, S. J.(2014).Pathology of invasive breast cancer.Diseases of the Breast
6. Dua, P.,Heiland, M. F.,Kracen, A. C.,Deshields, T. L.(2017).Cancer-related hair loss: a selective review of the alopecia research literature.Psycho-Oncology,26(4),438-443.
7. Koçan, S.,Gürsoy, A.(2016).Body image of women with breast cancer after mastectomy: A qualitative research.The Journal of Breast Health,12(4),145-150.
8. National Comprehensive Cancer Network (NCCN). (2020). NCCN clinical practice quidelines in oncology: Breast cancer. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
9. Swanson, K. M.(1993).Nursing as informed caring for the well-being of others.Journal of Nursing Scholarship,25(4),352-357.
10. Waks, A. G.,Winer, E. P.(2019).Breast cancer treatment: A review.Journal of the American Medical Association,321(3),288-300.
11. Wilson, B. J.,Zitella, L. J.,Erb, C. H.,Foster, J.,Peterson, M.,Wood, S. K.(2018).Prevention of Infection: A systematic review of evidence-based practice interventions for management in patients with cancer.Clinical Journal of Oncology Nursing,22(2),157-168.
12. Zhang, J.,Zhou, Y.,Feng, Z.,Xu, Y.,Zeng, G.(2018).Longitudinal trends in anxiety, depression, and quality of life during different intermittent periods of adjuvant breast cancer chemotherapy.Cancer Nursing,41(1),62-68.
13. 張金堅(2013)。化學治療的常見副作用—嗜中性白血球低下發燒。當代醫學，8(9)，573-581。
14. 陳淑娟,朱栩萱,陳淑娟,張桂玲,洪敏瑛(2014)。無縫接軌的腫瘤個案管理模式－臺大醫院經驗。源遠護理，8(2)，12-18。
15. 劉欣怡,章雅茜(2018)。運用身體心像模式於乳癌病人之照護經驗。澄清醫護管理雜誌，14(4)，62-70。
16. 衛生福利部國民健康署（2018，12月25日）· 105年癌症登記報告．取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=10227
17. 賴念華,王承蘭(2011)。女性罹患乳癌對家庭產生之影響。諮商與輔導，305，30-35。

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