照護一位腸穿孔老人接受暫時性腸造口之護理經驗

本文描述一位75歲老年婦女，因罹患腸穿孔而接受暫時性腸造口手術，因害怕面臨手術及留置腸造口而造成身體外觀改變，產生情緒低落、拒絕親友的關懷以及面對參與各種活動的意願低落；筆者於2016年11月14日至11月30日照護期間，藉由觀察、會談、身體評估及查閱病歷等方式收集資料，運用生理、心理、社會、靈性四大層面進行整體性評估，確立個案有急性疼痛、身體心像紊亂、個人因應能力失調等健康問題。經由與個案及家屬建立良好治療性人際關係，鼓勵個案表達內心感受及主動參與自我照顧計劃，提供明確的疾病相關資訊及具體說明後續治療計畫，並適時給予讚美，增進個案自信心，進而提升參與腸造口自我照顧的學習動機及以正向的態度來面對疾病。同時運用跨領域團隊照護模式及擬定個別性的護理措施，提升返家後的照護技巧，同時協助個案面臨腸造口所造成的心理衝擊。希望提供此經驗，做為日後相關疾病照護之參考。

關鍵字

腸穿孔；腸造口；護理經驗

並列摘要

This article described a 75-years-old woman who has suffered from intestinal perforation and accepted surgery with temporary enterostomy. She felt depressed, refused relatives and friend's care, and faced low willingness to participate in various activities due to fear of changing body appearance caused by surgery and leave enterostomy. The authors collected information through observation, talks, physical evaluation and medical records during the period of care from November 14, 2016 to November 30, 2016. We used four aspects of physiology, psychology, society and spirituality as a whole sexual assessment to establish the nursing problem of this patient, including acute pain, disturbance of body image, and individual coping ineffectiveness by encouraging the case to express her inner feelings and take part in self-care programs through providing good therapeutic interpersonal relationships with her family, providing clear information about the disease and follow-up treatment plan, giving compliments in a timely manner, enhancing self-confidence of individual cases, and further enhancing her motivation to participate in self-care of stoma and facing the disease in a positive manner. At the same time, cross-section team care model and individual care measures were developed to enhance the care skills after returning home and at the same time assist the individual in facing the psychological impact caused by stoma. It is hoped to provide this experience as a reference for the future care of the disease.