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運用長照政策以居家護理師角色教導照顧者學習照護大腸癌術後患者之護理經驗
The Nursing Experience of Patient after Colorectal Cancer Surgery Is Provided by Home Nurses
摘要
本文描述一位罹患第四期大腸癌患者進行乙狀結腸切除術後，於腹部存留腸造口個案之護理經驗。因癌症術後體力驟降，日常生活需密集協助，由年邁案妻協助照顧事宜，突然面對龐大照顧事務須學習而使照顧者身心不堪負荷，筆者瞭解協助新手高齡照顧者減輕照顧負荷之重要性，故引發探討動機。照護期間為2019年9月5日至2019年9月23日，以觀察、溝通、傾聽、直接照護及電訪追蹤等方式收集資料，並運用Gordon十一項健康功能型態評估結果加以分析，確立主要健康問題有：主要照顧者照顧知識缺失、主要照顧者角色緊張、皮膚完整性受損等三項。針對上述問題，運用技術示範及製作腸造口照護衛教圖卡、飲食建議，進而改善照顧者知識缺失問題。引導照顧者說出壓力源並與家庭其他成員討論照顧分工，介入社會資源協助，給予照顧上之肯定與支持，減少照顧者角色緊張。教導照顧長期臥床且失禁個案會陰部清潔照顧技巧，保持環境通風與選擇合宜的包覆工具，維持皮膚完整性。筆者透過本次照護經驗，體悟長照2.0服務從急性醫療由出院準備服務無縫接軌到社區之重要性，讓居家護理師到宅提供專業護理指導及照顧者心理層面的評估與協助，以延續性照護重拾照顧者信心。
並列摘要
This article describes the nursing experience of a patient with stage IV colorectal cancer who had an intestinal stoma in the abdomen after sigmoid colectomy. Due to the sudden drop in physical strength after cancer treatments, intensive assistance is required in daily activities. Learning those assistance skills and workload had made his aged wife who is his main caregiver was overwhelmed physically and mentally. The author acknowledges that is important to guide the aged caregiver about how to manage the heavy workloads, which also become a motivation to conduct the article. The nursing care period is from 5th -23rd of September in 2019. Data collected via the strategies of observation, communication, listening, direct care and telephone interview. The Gorden Assessment Tool was used to evaluate and analyze. Three main issues have identified: 1.The main caregiver deficient knowledge; 2.Caregiver role strain; 3.Impaired skin integrity. In response to above issues, the lack of knowledge in caregiver could be improved by the way of technical demonstration, visualized enterostomy care charts and appropriate dietary guidance. Guide the caregiver manage the workloads, discuss the division of care with other family members, introduce the community resources, provide support and affirmation to the main caregiver, help reduce the tension in the role of caregiver. Teach the main caregiver on perineal cleaning also the care techniques for long-term bedridden and incontinent case are important. Keep the environment ventilated and choose appropriate covering tools to maintain skin integrity. According to those real-care experience, the author has realized the important of the seamless integration of long-term care 2.0 services for the patient who has discharged from acute clinical setting to home, that has enabled home nurse to provide professional care guidance, psychological assessment, and assist the caregiver to regain the confidence within the professional continues care.