運用羅氏適應模式照護一位初次罹患口腔癌病患之護理經驗

A Nursing Experience of Applying Roy's Adaptation Model to a Patient with a First Diagnosis of an Oral Cancer

謝蕙青(Hui-Ching Hsieh)；雷琇惠(Hsiu-Hui Lei)

口腔黏膜障礙 ； 身體心像紊亂 ； 焦慮 ； 羅氏適應 ； 理論 ； impaired oral mucous membrane ； disturbed body image ； anxiety ； Roy's adaptation model

若瑟醫護雜誌

9卷1期（2015 / 07 / 01）

121 - 134

繁體中文

本篇探討一位初次罹患口腔癌個案，面臨身、心、靈的衝擊之護理經驗，筆者運用羅氏適應、模式理論進行護理評估，於2012年3月31日至2012年4月9日護理期間，運用觀察、會談、評估及查閱病歷等方式收集資料，確認個案主要有急性疼痛、口腔黏朕障礙、身體心像紊亂、焦慮、等護理問題，經由護理人員關懷、傾聽、支持與陪伴，運用團隊人員合作幫助個案解決生理問題及提供心理支持，鼓勵個案面對疾病及增進自信心並改善個案及家屬的焦慮，及協助個案術後疾病的適應及恢復自信心，和提供家屬相關照護技能，進而提升個案的生活品質，筆者藉此照護經驗，期望能提供護理人員在照護類似病人之參考，建議照護此類個案時，需提早於術前提供口腔癌照護諮詢，以減少術後引起之問題，並經由跨團隊照護，解決個案生、心理層面問題，使個案更快走出陰影及進入職場。

This paper describes the nursing experience of assisting a patient who had a first diagnosis of an oral cancer in facing physical, psychological, and spiritual impacts. The nursing assessment was conducted with the application of Roy's adaptation model. Data were collected through observations, interviews, physical assessment, and chart review during the nursing period from March 31 to April 9 in 2012. The health problems were identified as follows: (1) acute pain, (2) impaired oral mucous membrane, (3) disturbed body image, and (4) anxiety. The author provided attention, listening, support, and companionship, with the cooperation of the team, to help the patient solve physical problems and provide him psychological support, to encourage him to face the illness and promote self-confidence, to reduce his and family's anxiety, to help him adapt to the disease after surgery and gain self-confidence, and to provide family caregivers with care skills, thereby improving the patient's quality of life. This paper is expected to share the nursing experience with nursing professionals and could be a reference for similar cases. When caring for such patients, we suggest that pre-operative nursing counseling be provided to reduce the problems resulted from surgery. We also suggest that interprofessional cooperation be applied to solve patients' physical and psychological problems, facilitating them to get out of the shadows and return to the workplace soon.

1. Berry, AM.,Davidson, PM.(2006).Beyond comfort: Oral hygiene as a critical nursing activity in the intensive care unit.Intensive & Critical Care Nursing,22,318-328.
2. Chen, SC.,Liao, CT.,Chang, JT.(2009).Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery.Oral Oncology,45,815-820.
3. Feber, T.(2000).Philadelphia Whurr.
4. Hannon-Engel, S.L(2008).Knowledge developmentǺThe Roy adaptation model and bulimia Nervosa.Nursing Science Quarterly,21,126-132.
5. Hanson, C.(2004).Mouth care - how important is it.Journal of Community Nursing,18,4-6.
6. Hassanein, KA.,Musgrove, BT.,Bradbury, E.(2005).Psychological outcome of patients followingtreatment of oral cancer and its relation with functional status and coping mechanisms.Journal of Cranio-Maxillo-Facial Surgery,33,404-409.
7. Roy, C.(2009).The Roy adaptation model.N J Prentice Hall Health.
8. 王淑貞,胡薰丹,林幸姿(2003)。林幸姿等：口腔護理方案對末期病患口腔黏膜成效之探討。安寧療護雜誌，8，199-209。
9. 李和惠（編輯）,林麗秋（編輯）,黃玉琪（編輯）,吳碧雲（編輯）(2008).內外科護理學.台北:華杏出版公司.
10. 林美瑩,柯薰貴(2008)。一位口腔癌末期病患之護理經驗。腫瘤護理雜誌，8，51-63。
11. 俞美莉,周繡玲(2004)。口腔癌末期病患照護之護理經驗：一個案報告。安寧療護雜誌，9，394-406。
12. 陳淑卿(2007)。口腔癌病患手術後之生活經驗。腫瘤護理雜誌，7，13-23。
13. 陳靜怡,黃惠玲,莊情惠(2010)。一位口腔癌接受重建手術後有自殺意念病患之護理經驗。長庚護理，21，109-117。
14. 黃振勳,王東堯,張倍榮(2008)。口腔顎顏面手術病患術後使用靜脈自控式止痛術的成效評估。台灣口外誌，19，260-267。
15. 蔡紫暄,周繗玲,陳麗系(2011)。腔癌患者術後症狀困擾及相關因素討。腫瘤護理雜誌，11，23-35。
16. 衛生福利部: 2011年死因結果摘要表。2012。取自於http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=12336&class_no=440&level no=4
17. 衛生福利部: 2011年主要死因分析。2012。取自http://www.doh.gov.tw/

1. 陳麗琴,陳淑卿,邱慧娟,林秀珍(2019)。一位大腸直腸癌篩檢陽性病患之護理經驗。腫瘤護理雜誌，19(增訂刊)，77-88。
2. 謝佳君,李怡珍(2017)。運用羅氏適應模式於一位左眼角膜潰瘍個案之護理經驗。若瑟醫護雜誌，11(1)，115-126。