照顧因永久性腸造口導致身體心像紊亂病人之護理經驗

Nursing Experience of Caring a Patient with a Permanent Colostomy and Disturbed Body Image

10.6740/NTUHJN.202101_17(1).0009

謝旻桂(Min-Kuei Hsieh)；許曉萍(Hsiao-Ping Hsu)；林盈秀(Ying-Siou Lin)

腸造口 ； 身體心像 ； 大腸直腸癌 ； 急性疼痛 ； 焦慮 ； colostomy ； body image ； colorectal cancer ； acute pain ； anxiety

臺大護理雜誌

17卷1期（2021 / 01 / 01）

90 - 100

繁體中文

本文描述一位大腸直腸癌個案接受腹部會陰切除手術，術後需建立永久性腸造口而導致個案身體心像紊亂的照護經驗。因個案未預期術後即留置永久性腸造口，後續出現身體心像改變的困擾，加上術後急性疼痛需處理，為本個案照護經驗分享的動機。於2018年12月23日至2019年1月8日透過臨床照護、身體評估及會談的方式收集資料，運用生理、心理、社會與靈性之整體性評估，確立個案有急性疼痛、身體心像紊亂與焦慮等健康問題。針對上述健康問題給予個別性護理措施，包括：協助個案以藥物及非藥物的疼痛處置以緩解術後急性疼痛；依據身體心像改變調適的四個階段：衝擊、退縮、承認和重建期，提供個案不同階段的照護內容，採漸進式方式讓個案能接受腸造口的存在並願意學習自我照護技能；藉由腸造口模型指導個案照護技能，出院前能執行腸造口自我照護並減輕焦慮，最後重返家庭及社會生活。建議未來能於手術前能提供更完整多元之腸造口照護相關知識，以減輕病人的術前焦慮與術後身體心像改變帶來的心理衝擊。

This article describes the nursing care experience of a patient with colorectal cancer with a permanent colostomy after abdominal perineal resection who also had a body image disturbance. Data were collected accomplished by interviewing the patient, performing a physical examination, and providing clinical nursing care from December 23, 2018 to January 8, 2019. An integrated physical, psychological, social, and spiritual assessment was conducted to identify the associated health problems, including acute pain, body image disturbance, and anxiety. Nursing interventions were implemented for the individual's health problems. First, this patient was treated with pharmacological and nonpharmacological pain management to relieve acute pain after surgery. Furthermore, appropriate interventions were provided for this patient to facilitate acceptance of the colostomy and self-care according to the adaptive process of the four stages of body image changes. Finally, the ostomy care model was used to educate this patient on how to care for the colostomy, thereby allowing this individual to practice self-care before being discharged and returning to family and social life. Nurses should provide the knowledge about colostomy care before abdominal surgery to help reduce anxiety and the psychological impact of body image changes.