運用身體心像模式於乳癌病人之照護經驗

Nursing Experience of Using the Body-image Care Model on a Breast Cancer Patient

劉欣怡(Hsin-I Liu) ； 章雅茜(Ya-Chien Chang)

《澄清醫護管理雜誌》 14卷4期 (2018/10) Pp. 62-70

摘要

乳癌術後及其合併症常導致病人面對生理及心理層面的改變，引起身體心像紊亂的問題，本篇為運用身體心像照護模式於一位乳癌合併腫瘤蕈狀傷口病人負面身體心像之護理經驗。筆者於病患因敗血性休克住在加護病房的護理期間，除了提供敗血性休克之急性護理照護，運用身體心像照護模式作評估及照護指引，發現病人因乳癌術後合併腫瘤蕈狀傷口惡化導致身體心像紊亂之護理問題，延伸有社交退縮行為，因此藉由同理心的主動關懷、提供身體心像模式中的預防、支持、衛教、諮商及聯絡社會支持網路和病友支持機構等護理措施，增進病人生理舒適並予心理支持，提供正向社會支持系統，使其轉為正向面對身體的改變及增進傷口自我照護能力，改善社交退縮情形。乳癌對於女性身心影響甚鉅，希望藉由本文提供重症護理人員臨床照護參考。

關鍵字

乳癌 ； 腫瘤蕈狀傷口 ； 身體心像照護模式 ； 身體心像紊亂

並列摘要

Breast cancer surgery and postoperative complications often lead to changes in patients' physiological and psychological conditions, giving rise to the issue of body image disturbance. The purpose of this article is to report the nursing experience of using the body-image care model to handle the negative body image of a breast cancer patient with malignant fungating wounds. When the patient was admitted to the intensive care unit for septic shock, the author not only provided critical care to treat her condition but also employed the body-image care model as an evaluation tool and as a nursing care guide. The patient was found to be suffering from body image disturbance due to the postoperative deterioration of her fungating wounds, which in turn led to social withdrawal behavior. Nurse-expressed empathy and other nursing measures suggested by the body-image care model-including preventive care, supportive care, patient education, counseling, and communication with the social support network and patient support agencies-were adopted to enhance the patient's physical comfort and provide her with mental support and a positive social support system. The aim was to help her confront her physical changes with a positive attitude, fostering her self-management of wound care, and mitigating her social withdrawal behavior. With regard to the immense impacts of breast cancer on women's body image, it is hoped that this paper serves as a reference for the clinical practices of critical care nurses.

並列關鍵字

Breast cancer ； Fungating wounds ； Body-image care model ； Body image disturbance