運用羅氏適應模式於一位喉癌病人之護理經驗

A Nursing Experience of Applying Roy's Adaptation Model to a Patient with Laryngeal Cancer

莊琍麟(Li-Lin Chuang) ； 柯幸芳(Hsing-Fang Ko) ； 包世芳(Shi-Fang Pai)

《志為護理-慈濟護理雜誌》 12卷2期 (2013/04) Pp. 91-101

摘要

本文為一位65歲女性喉癌病人之護理經驗，病人在面臨確診為早期喉癌後出現情緒低落、哭泣等負向情感反應及對未來感到無望；喉顯微手術後併有咽喉黏膜受損，為避免聲帶緊張及震動而須禁聲，造成病人與家屬有溝通衝突發生。筆者於2010年8月10日至9月20日護理期間，運用傾聽、筆談及羅氏適應模式作為整體性評估，確立問題有無望感、身體心像紊亂、言辭溝通障礙。護理過程中，心理方面藉以關懷陪伴，偕同家屬建立良好的支持系統，運用生命回顧及宗教信仰的方式，強化病人對生命的態度和價值；生理方面則鼓勵於禁聲期間採筆談溝通，輔以手勢及畫冊表達需求及感受，促進與他人溝通表達之能力，達到讓病人重新學習因應方法以獲得調適。

關鍵字

喉癌 ； 羅氏適應模式 ； 護理經驗

並列摘要

The article described a nursing experience of a female patient with laryngeal cancer. The patient exhibited negative emotional responses such as depression, sobbing and hopelessness upon receiving a confirmed diagnosis of early-stage laryngeal cancer. The disease was complicated by damage to the throat mucosa post laryngeal microsurgery. The patient was to remain silence to avoid tension and vibration to the vocal cord, resulting in communication conflicts between the patient and the family. From August 10 to September 20, 2010, the author applied attentive listening, written communication and Roy's adaptation model as a full evaluation of the patient, confirming major issues including hopelessness, body image disturbance and impaired verbal communication. During the caring process, the author assisted the patient psychologically through life review and religious tenet to rebuild her faith in life and accept the scars left from the surgery. On the physical side, the author suggested written communication during silence period in conjunction with sketchpads and hand gestures for the patient to express her needs and feelings and furthermore improve her social communication skill. These nursing interventions were implemented to ultimately aid the patient to adjust by studying coping techniques.

並列關鍵字

laryngeal cancer ； nursing experience ； Roy's adaptation model