一位肝癌手術後個案無望感之加護經驗

The Intensive Care Experience: A Hopeless Person After Hepatocellular Carcinoma Surgery

陳佳倩(Chia-Chien Chen)

《志為護理-慈濟護理雜誌》 16卷3期 (2017/06) Pp. 95-105

摘要

本文描述一位肝癌個案行肝切除手術後面臨身、心衝擊之照護經驗。護理期間為2014年1月10日至1月16日，運用羅氏適應理論為評估架構，藉由直接照顧、觀察、會談及身體評估等方式收集資料，分析並歸納出個案有急性疼痛、潛在危險性感染、睡眠形態紊亂及無望感等健康問題。護理過程中藉由陪伴與傾聽，建立信任的護病關係，運用數字量表評估疼痛指數，鼓勵個案表達對疼痛感受，提供合宜的照護及減輕疼痛方法；執行護理治療採集中護理，給予耳罩及眼罩減少外在刺激，提供舒適的環境；並以同理心面對個案的低落情緒，給予正面能量，協助度過無望感之危機，使其適應疾病造成的生活改變。

關鍵字

肝癌 ； 急性疼痛 ； 無望感

並列摘要

The article described the nursing experience of a hepatocellular carcinoma patient who experienced physical and psychological trauma after liver resection. The nursing period lasted from Jan. 10th to Jan. 16th, 2014. By using Roche's Adaptation Model as a theoretical framework for assessment, data were collected using direct care, observation, interviews, and physical assessment. The analysis of data identified health issues such as acute pain, risk of infection, sleep pattern disturbance, and hopelessness. During the nursing process, we established a trusting patient-nurse relationship through companionship and listening. Numerical rating scale was applied to encourage the patient to express level of pain, and in response appropriate care and pain mitigation techniques were provided. Cluster nursing activities were implemented with earbuds and blindfold to offer a comfortable environment and minimize external stimulation. Empathy was used to confront the depressive mood of the patient with positive energy, assisting the patient to overcome hopelessness, and cope with the alteration to lifestyle induced by the disease.

並列關鍵字

acute pain ； hopelessness ； hepatocellular carcinoma