運用羅氏適應理論照護一位下肢骨肉瘤病人接受截肢手術後之護理驗

本文探討一位下肢罹患惡性骨肉瘤的中年女病患接受截肢處置後造成其生理、心理以及自我價值嚴重衝擊之護理經驗。護理期間自2018年5月11日至2018年5月30日，筆者運用羅氏適應理論評估架構，藉由病歷記錄、會談、身體評估與直接護理照護等方式收集資料，確立個案有焦慮、疼痛、身體心像紊亂以及身體活動功能障礙等健康問題。這些健康問題主要與個案對疾病本身不了解、不確定手術處置過程及結果、截肢導致之傷口以及外觀功能改變等因素有關。經筆者運用陪伴、傾聽以及鼓勵個案表達感受，緩解其焦慮；利用藥物與教導非藥物方式控制疼痛；配合物理治療師，鼓勵個案強化上肢及健側肌力、站立及坐姿平衡等訓練，以及鼓勵運用適當輔具移動肢體，避免侷限於床上活動，使其能早期下床並為日後穿上義肢做準備；同時，筆者採主動關懷及同理心與個案建立良好的護病關係，協助面對截肢術後身體完整性的改變，並提供中華民國骨肉癌關懷協會、台灣癌症基金會等支持團體分享，以重建正向的自我概念，增強自信心，並提升自我價值感，協助盡早回歸原本正常生活。

關鍵字

骨肉瘤；截肢；身體心像紊亂；羅氏適應理論

並列摘要

This article is to describe a nursing experience of a mid-aged woman whose lower-extremity was amputated due to a malignant osteosarcoma that led to a major impact on her body, mind and self-valuation. During the nursing care period from May 11th to 30th of 2018, the author utilized Roy's adaptation model as an assessment framework by reviewing patient's medical records, interview, physical examination, and direct care to collect data and established patient's health problems as followed: anxiety, acute pain, disturbed body image, and impaired physical mobility. Mainly, these health problems were related to the patient's unfamiliarity with the process and outcome of disease and surgical management, the wound, and the changes in appearance and functions. The author provided companionship and listening, and encouraged expressing feelings to relieve patient's anxiety. In addition, used medications and non-medication skills to help patient to control the pain. Furthermore, encouraged patient participating in the physical rehabilitation program to help strengthening her extremity muscle groups and practice sitting and standing positions. She was also been taught to use the prosthesis to prevent her from restricted to bed-rest which could get her off bed and prompted an early preparation for wearing prosthesis. Facing the post-surgical changes physically and functionally that has led to a complete strange to the patient's life. Several foundations and supporting groups were recommended in hoping the patient will have further support and regain her self-confidence and self-valuation positively. With these means, we hope that the patient can return to regular daily activities as soon as possible.

並列關鍵字

osteosarcoma ； amputation ； body image disturbance ； Roy's adaptation model

參考文獻

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