照顧一位初次罹患直腸癌婦女接受手術治療之護理經驗

罹患癌症易讓人有面臨死亡的恐懼，常被視為一種嚴重的壓力來源，本文旨在探討一位初次罹患直腸癌之婦女，行直腸腺癌切除併淋巴廓清術之前後，除了面臨罹癌的衝擊外，對術後未知的結果也導致個案及照顧者產生焦慮及感到挫敗感。於2014年7月22日至8月1日護理期間筆者利用與個案進行溝通、觀察及與主要照顧者進行會談等方法，運用Gordon十一項健康功能型態評估，確認個案四項護理問題，(一)焦慮/與迫近的手術和診斷罹癌有關、(二)急性疼痛/與術後傷口有關、(三)潛在危險性感染與傷口及管路留置有關、(四)照顧者角色緊張/家屬對術後未知的結果有關。護理期間建立良好護病關係，除了使用藥物控制疼痛不適外，護理過程中也以傾聽來接納個案心中感受、提供主動關懷、陪伴與情緒支持，提供適切的護理，透過衛教個案深呼吸、教導案夫執行足部按摩、傾聽信仰的宗教音樂等個別性衛教指導維持生理舒適，有效降低疼痛感、焦慮情緒，同時於住院期間給予個案及家屬相關支持團體資料，並適時做追蹤，在此提出與大家分享護理經驗，做為日後臨床之照護參考。

關鍵字

直腸癌；焦慮；疼痛；照顧者角色緊張

並列摘要

Patients diagnosed with cancer are inclined to facing fear of death, a source of heavy stress. This case study aims to explore anxiety and frustration in a female rectal cancer patient facing post-surgical removal of the rectum and lymph node dissection. The nursing care period was from July 22 to August 1, 2014. With the application of Gordon's eleven functional health pattern assessment, the nursing diagnosis and care plans included (1) anxiety relevant to the surgery and diagnosis of cancer, (2) acute pain related to post-surgical incision, (3) potential risk of infection related to post-surgical incision and an indwelling catheter, and (4) the caregiver's role tension related to unknown post - surgical results. The author incorporated the following nursing techniques: establishing a good nurse-patient relationship, managing pain and discomfort with medication, listening to the patient's internal feelings, providing active caring, companionship, and emotional support, and providing individualized nursing care, including patient education regarding deep breathing, foot massage, and relaxing music, to reduce the patient's psychological distress and anxiety. The patient and family received information regarding support groups and follow-up during hospitalization. The authors shares this nursing experience as a clinical nursing reference.

並列關鍵字

Colon-rectum cancer ； Anxiety ； Pain ； Caregiver's Role strain

參考文獻

Bradt, J., Dileo, C., Grocke, D., Magill, L. (2011). Music interventions for improving psychological and physical outcomes in cancer patients (Review). The Cochrane database of systematic reviews ,1-98. doi: 10.1002/14651858.CD006911

Hazelowood, D. M., Koeck, S., Wallner, M., Anderson, K. H., Mayer, H. (2012). Patients with cancer and family caregivers: management of symptoms caused by cancer or cancer therapy at home. Heilberufe Science, 3(4), 149 -158. doi: 10.1007/s16024-012-0118-z

Zhou, K., Li, X., Li, J., Liu, M., Dang, S., Wang, D., Xin, X. (2014). A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: Results on depression, anxiety and length of hospital stay. European Journal of Oncology Nursing, 3889(14), 1-6. doi: 10.1016/j.ejon.2014.07.010

王桂芸、馮榮芬、李惠玲、谷幼雄、周桂如、高啓雯…歐嘉美等（2014） •消化系統疾病與護理：新編內外科護理學上冊（五版, 144-155頁）•台北市：永大書局。