應用個案管理師角色功能照護一位中斷治療鼻咽癌患者之護理經驗

A Case Manager's Nursing Experiences of a Nasopharyngeal Cancer Patient Discontinuing Treatment

黃鈺婷(Yu-Ting Huang) ； 張桂玲(Guey-Ling Chang) ； 崔宛玉(Wan-Yu Tsui)

《腫瘤護理雜誌》 13卷2期 (2013/12) Pp. 51-63

https://doi.org/10.6880/TJON.201312_13(2).06

摘要

本文是運用個案管理師角色功能協助一位初次接受同步化學與放射線治療的中年男性鼻咽癌患者之護理經驗。護理期間自2011年6月16日至2011年10月13日，藉由與個案互動、觀察與會談等方式進行整體性的健康評估，收集身體、心理、社會及靈性等層面資料，加以分析並歸納出個案之健康問題，包括口腔黏膜改變、疼痛、不遵從與無力感等。筆者為患者之腫瘤個案管理師，照顧期間運用關懷照護的技巧，在疾病診斷期間主動關懷個案與個案建立良好的治療性關係，且提供疾病各項檢查與疾病治療計畫的相關訊息，在治療期間並針對個案的健康問題擬定個別性之護理計劃，教導個案執行口腔清潔照護的技巧，加強對止痛藥物使用的認知與正確觀念，在個案中斷治療及面對疾病與治療副作用導致無力感時，提供疾病相關資訊與諮詢，協助聯繫相關醫療人員，適時的給予正向鼓勵、關懷、情緒支持與表達，使個案重新面對疾病且順利完成治療。個案完成治療進入追蹤期後則以電話訪談進行關懷，且提供持續性照護，以提升患者疾病治療後重新適應生活。此為發揮腫瘤個案管理師之護理獨特功能，期望能提供日後照護類似個案之參考。

關鍵字

個案管理 ； 中斷治療 ； 鼻咽癌

並列摘要

This case report presents nursing experiences of a case manager who took care of a middle-aged male nasopharyngeal cancer patient receiving concurrenty chemotherapy and radiotherapy from June 16 to October 13 in 2011. Data of the patient's physical, psychological, social and spiritual dimensions was collected through a general health assessment, observation, interactions and interviews with him. The patient health problems were identified as impaired oral mucous membrane, pain, noncompliance, and powlessness. As a case manager in the oncology unit, the authors provided active caring and the information related to the diagnosis, examinations and treatments, and established therapeutic relationship with the patient during the period of nursing care. Furthermore, the case manager created an individualized care plans based on the patient's health problems, educated the patient about mouth care, increased the patient's knowledge on the use of analgesic drugs, answered the questions regarding his generalized powlessness caused by the side effects of the treatments, and provided disease-specific information. The authors also positively encouraged the patients, and provided appropriate caring and emotional support to help the patient face the challenge of his disease, and to complete treatments successfully. Following the treatments, care was provided to the patient through telephone interviews to help him readjust his life during the follow-up. It is expected that the unique roles and functions of the case manager in the oncology unit can serve as a reference for clinicians to nursing care of those patients with the similar situations.

並列關鍵字

case manager ； discontinued treatment ； nasopharyngeal cancer