本文描述一位產後母乳哺餵約四個月後診斷為乳癌之婦女,除了面臨手術造成之生理不適外,另因治療過程擔憂乳房外觀改變及往後哺乳抉擇之困擾,使得生理及心理面臨極大衝擊及壓力之護理經驗。筆者於2018年11月1日至11月13日照護期間,採用Gordon十一項健康功能型態作為評估工具,經由觀察、傾聽、身體評估及查閱病歷等方式收集相關資料,確立個案有急性疼痛、母乳哺餵增進之準備度及身體心像改變等健康問題,於照護期間適時的給予止痛藥物與非藥物治療方式以轉移對疼痛之不適,藉由護理衛教及運用家庭成員給予良好支持系統,以共同討論方式增加母乳哺餵的準備度,進而達到母乳哺餵的持續性,以落實母嬰健康,另藉由與個案建立良好護病關係,運用相關醫療團隊給予專業資訊,提供正確的衛教內容,使個案能勇敢的面對身體心像的改變及正向的看待自我,以達身心靈之健康。建議可透過乳癌無縫服務,整合就醫流程、客製化醫療,將跨專業醫療照護人才運用於臨床治療中,建立以病人為中心的整合性照護,提供無縫的健康照護服務。
This article describes a postpartum woman who was breastfeeding for approximately four months and then was diagnosed with breast cancer. Apart from facing the physical uncomfortableness caused by the surgery, the patient also suffered from great physical and mental impact and stress from worrying about the change of the breast appearance and the dilemma between breastfeeding or not. During the nursing days from November 1 to November 13, the author adopted Gordon 11 Function Health Patterns as an assessment tool and used observing, listening, physical assessment, and looking up medical records to collect data. It was assumed that the patient had acute pain, problem of readiness for enhanced breastfeeding, and health problem like the body image change. During the nursing period, the patient was timely provided with painkillers and non-medical treatment to distract her from pain. Through nursing and health education, the use of family members to provide a good support system, and joint discussion to increase the readiness of breastfeeding, they aim to achieve the continuity of breastfeeding and to implement maternal and child health. In addition, by establishing a good nursing-patient relationship, using the relevant medical team to provide professional information, and providing the correct content of health education, the patient could bravely face the changes in the body and mind and view herself positively, so as to achieve physical and spiritual health. It is suggested that establishing patient-centered integrative care through breast cancer seamless service, integrating medical procedures and precision medicine, and combining multidisciplinary health care staff with clinical treatment can provide the seamless health care service.