運用不確定感理論照顧一位胸腺惡性腫瘤之個案

Apply Mishel's Uncertainty in Illness Theory to Take Care of a Patient with Thymic Carcinomas

藍雅婷(Ya-Ting Lan)；黃怡真(Yi -Chen Huang)

不確定感理論 ； 胸腺腫瘤 ； 護理經驗 ； Uncertainty Theory ； Thymus Malignant Tumor ； nursing experience

若瑟醫護雜誌

12卷1期（2018 / 10 / 01）

124 - 134

繁體中文

本文旨在描述照護一位胸腺惡性腫瘤行微創手術，術後傷口感染之個案，在面臨疾病、治療及預後產生不確定感之加護病房護理經驗，照護期間為2014年5月17日至6月4日，筆者運用觀察、筆談等方式，以Mishel不確定感理論為架構收集資料並進行分析，發現個案在加護病房期間出現三階段不確定感之行為，包括一、對疾病進展的不確定感；二、對治療過程的不確定感；三、對返家照護的不確定感。個案依其年齡在自我照顧上應當有能力，卻因傷口感染導致再次入院，護理過程發現個案家庭支持系統薄弱，難以支撐心理對疾病進展或變化所產生的不確定感。疾病初期，個案需面對無法預知之未來，對其心理調適及治療過程易產生負面影響，以不確定感理論為介入依據，探索個案因不確定感所致的焦慮、害怕，再予心理支持、經驗分享及衛教疾病症狀等護理措施，協助個案和家屬度過生理與心理上之危機。

The purpose of this article is to describe intensive care unit nursing care for a patient with Thymus carcinoma undergoing minimally invasive surgery with postoperative wound infection, who feel uncertainty in the treatment of disease, treatment, and prognosis. The care period is from 17 May to 4 June, 2014. Based on Mishel's Uncertainty in Illness theory, the author used observation and conversation by writing to collect patient information and implement analysis. The results show that patient appear three stage of uncertainty behavior in the intensive unit, which include 1. Uncertainty about disease progression. 2. Uncertainty about the treatment process. 3. Uncertainty about post-discharge care. The patient should have self-care ability according to his age. However, he was admitted again because of a wound infection. The nursing process found that the family support system was weak and it was difficult to support the psychological uncertainty of the progress or change of the disease. At the initial stage of the disease, the patient needs to face an unpredictable future, which may have a negative impact on psychological adjustment and treatment process. Using the theory of uncertainty as the basis for intervention, exploring the patient anxiety and fear caused by the uncertainty, and providing psychological support, experience sharing, and the education of disease symptom, etc., to assist the patient and the family get pass the physical and psychological crisis.

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