協助一位甲狀腺腫瘤病人接受氣切造口術後之出院準備服務經驗

Discharge Planning for a Patient with Thyroid Tumor after Tracheostomy

10.6880/TJON.202212_22(2).11

蔡佩純(Pei-Tsun Tsai)；張雅燕(Ya-Yan Chang)；劉麗珒(Li-Ching Liu)；林惠敏(Huei-Min Lin)；賴維淑(Wei-Shu Lai)

出院準備服務 ； 無力感 ； 家庭因應能力失調 ； 甲狀腺腫瘤 ； discharge planning ； powerlessness ； family support ； ineffective family coping ； thyroid tumor

腫瘤護理雜誌

22卷2期（2022 / 12 / 01）

141 - 152

英文

本文係探討一位67歲罹患甲狀腺腫瘤之女性面臨手術後留置氣切套管以及照護資源薄弱之護理經驗。護理期間為2019年4月23日至2019年5月3日，藉由直接照護、家庭評估、身體評估、觀察，與家屬會談及跨團隊合作討論會議等方式收集健康相關資料，發現個案有呼吸道清除功能失效、無力感、家庭因應能力失調三個主要健康照護問題。護理期間透過個別性之護理措施緩解個案生理不適，深入了解個案及家屬內心之壓力與潛藏的需求，藉由與個案會談、召開家庭會議、跨團隊合作討論會及透過社工協調、探討家屬面對個案照護及壓力源，協助家屬了解個案後續照護及發展家庭因應措施，與家庭共同面對疾病所帶來的衝擊與壓力。透過出院準備服務，增加病人對疾病的自控感，妥善連結社會資源與銜接長期照護，幫助支持系統薄弱的家庭在失序中重建家庭內部的彈性、力量和潛能，以順利因應疾病歷程。

This article describes the experiences associated with providing nursing care to a 67-year-old woman with a thyroid tumor who underwent a tracheostomy and had little support system and care resources. The nursing period was from April 23 to May 3, 2019. Health-related information was collected via direct care, family assessment, physical assessment, observations, family interviews, and cross-team discussions. Three major health problems were identified: 1) failure of the airway clearance function, 2) sense of powerlessness, and 3) ineffective family coping. During the nursing period, individualized nursing interventions were used to relieve the physical discomfort of the patient and to gain a deep understanding of the inner pressure and unmet needs of the patient and her family members. Via interviews with the patient, family meetings, cross-team collaboration discussions, and coordination among social workers, the caretaker stress faced by family members was discussed, the family was assisted in understanding the requirements of the patient's continuous care, family coping strategies were developed, and the family was supported with respect in dealing with the impact and pressure resulting from the illness. Through the discharge preparation services, the patient's sense of self-control regarding the disease can be increased, social and long-term care resources can be made available, and families with weak support systems can be assisted in rebuilding the resilience, strength and potential of the family to cope smoothly with the progression of the disease despite the pressures of disorder.

1. 唐鈺婷,康云,蔣立琦(2016)。以家庭為中心重症病人家屬的護理照護。領導護理，17(1)，2-13。
   連結：
2. Ackley, B. J.,Ladwig, G. B.,Makic, M. B. F.(2017).Nursing diagnosis handbook: An evidence-based guide to planning care.St. Louis, MO:Elsevier.
3. American Hospital Association(1983).Introduction to discharge planning for hospital.IL:American Hospital Association.
4. Morris, L. L.,Whitmer, A.,McIntosh, E.(2013).Tracheostomy care and complications in the intensive care unit.Critical Care Nurse,33(5),18-30.
5. 尹裕君,杜異珍(2000)。氣切患者出院準備服務計畫之執行。榮總護理，17(4)，383-390。
6. 王昭凌,李佳倫(2013)。一位口腔癌接受氣管切開術病人的照護經驗。馬偕護理雜誌，7(1)，83-93。
7. 王桂芸（校閱）,劉雪娥（校閱）,馮容芬（校閱）(2017).新編內外科護理學.台北市:永大.
8. 田又伃,楊逸菊,黃莉棋,林幸慧(2018)。甲狀腺腫瘤臨床判斷及處置。家庭醫學與基層醫療，33(4)，103-109。
9. 李俞潔,辛文蕙,張秀美(2017)。一位甲狀腺癌病人接受氣管造口與鼻胃管後身體心像紊亂之護理經驗。馬偕護理雜誌，11(2)，71-81。
10. 許文,李璧伊,湯振青,陳思豪(2018)。談出院準備服務。家庭醫學與基層醫療，33(10)，285-289。
11. 黃詩婷,陳繪竹,王姮樺,鄭碧芬,王美惠(2019)。一位下咽癌行全喉切除手術病人之照護經驗。高雄護理雜誌，36(1)，55-66。
12. 蘇清菁,陳玉敏(2009)。無力感之概念分析。長庚護理，20(4)，456-462。