照顧一位下咽癌個案行氣切造口術之護理經驗

本文探討一位下咽癌男性接受氣切造口術，面對術後身心調適及自我傷口照護之護理經驗。護理期間於2020年3月17日至4月10日，藉由觀察、直接照顧、筆談，運用全人照護評估-身心靈社會模式，確立個案健康問題為溝通障礙、身體心像紊亂與焦慮。個案住院期間正逢新冠肺炎盛行，因應防疫措施，家屬無法隨側關懷陪伴使其內心倍感孤寂。透過主動關心，適時陪伴與鼓勵，引導個案談論面對疾病、正向思考並與家屬攜手幽谷伴行；學習與疾病共融共好的健康態度，漸進式教導氣切照護技巧；引導觸摸造口接受外觀的改變，運用服飾配件修飾氣切造口，增加自我認同與自信；教導使用字卡、書信傳遞及通訊軟體LINE建立新的溝通方式。藉此照護經驗作為日後類似個案參考。

關鍵字

下咽癌；氣切造口術；溝通障礙；身體心像紊亂；焦慮

並列摘要

Patients with hypopharyngeal cancer often question the physical and mental adjustment and wound care after a tracheostomy of his life. It is essential to provide more appropriate care and achieve greater care efficacy. Between March 17th to April 10th, 2020, the authors conducted assessed three dimensions of care for the patient using observation, interviews, patient medical records, and share decision making. Meanwhile, hospitalization is the stage of COVID-19 epidemic prevention and infection control, the patient was diagnosed with cancer. Family members are unable to accompany him and weakly support him. Three dimensions included the relations between the individual and himself, others, religious belief, "communication disorder", "body image disturbance", and "anxiety". In the nursing care process, the author's employed one-to-one interviews with listening skills to build trust through active care, timely companionship, and encouragement, with the values of positive thinking to face the difficulties of disease and cope with his life. The author's employed education skills training to enhance disease progress and medical information, keep abreast of treatment progress, teach wound dressings to improve self-care ability, guide the tracheostomy around the touch, and gradually accept the changes in the body. Use accessories to increase self-identity and confidence, guide word cards, letter delivery, and communication software LINE to establish new communication methods. The result increased patient self-respect and quality of life. The authors hope this case may provide a reference for treating similar clinical cases in the future.

並列關鍵字

Hypopharyngeal cancer ； Tracheostomy ； Communication disorder ； Body image disturbance ； Anxiety

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