照護一位初診斷直腸癌病患於門診接受同步化學及放射線治療之經驗

Providing Nursing Care for a Newly Diagnosed Rectal Cancer Patient Receiving the Concurrent Chemo-Radiotherapy at Outpatient Department

林芳妙(Fang-Miao Lin) ； 張桂玲(Guey-Ling Chang) ； 洪敏瑛(Ming-Ying Hong) ； 崔宛玉(Wan-Yu Tsui)

《腫瘤護理雜誌》 14卷2期 (2014/12) Pp. 65-78

https://doi.org/10.3966/168395442014121402007

摘要

本文描述照護一位初次罹患直腸癌病患於門診接受同步化學及放射線治療之經驗。護理期間自2012年9月15日至2012年11月20日，藉由與個案互動、觀察及會談方式進行整體性評估，收集生理、心理、社會及靈性等層面資料，加以分析並歸納出個案之健康問題，包括疼痛、焦慮、照顧者角色緊張。筆者為個案之腫瘤個案管理師，在疾病診斷初期，主動關懷個案與個案建立良好的治療性關係，評估個案及其家屬照顧需求；在治療期加強個案對止痛藥物正確使用方法與認知，以及放射線治療期間之皮膚照護；在個案面對疾病及治療導致副作用產生焦慮時，給予傾聽及心理支持，提供疾病相關資訊，適時的給予正向鼓勵、關懷、陪伴及協助情緒表達。針對案妻因缺乏照護經驗產生緊張及壓力時，主動了解案妻緊張及壓力來源，增加其對疾病及副作用處理之認知，提供居家照護技巧，協助尋求家人支持及分擔照顧壓力，以減輕案妻照顧壓力及角色緊張之問題。個案完成治療進入追蹤期，仍以電話訪視方式提供持續性照護，以協助個案及家屬再次適應疾病治療後的新生活。本文可見腫瘤個案管理師獨特角色功能，期望此護理經驗可作為類似個案之參考。

關鍵字

直腸癌 ； 同步化學及放射線治療 ； 個案管理

並列摘要

This paper described the nursing experience for a rectal cancer patient during his concurrent chemo-radiotherapy. Nursing care was provided from September 15, 2012 to November 20, 2012. Through interactions, observation, and interviews with the patient, the case manager completed a comprehensive assessment, including data collection and analysis of the physiological, psychological, social, and spiritual aspects of the patient to summarize the patient's health problems of pain, anxiety, and also the pressure on the caregivers. The author, an oncology case manager, provided care to the patient. At the initial stage of diagnosis, the case manager established a positive therapeutic relationship with the patient in order to assess the patient and the patients' family needs. During the treatment period, the author focused on educating the patient on the correct use of analgesic drugs and on skin care. When patient was anxious about the cancer diagnosis and the side effects of radiotherapy, the case manager listened to him, provided psychological support and cancer-related information to the patient to relieve his emotional distress. At the same time, the case manager actively approached the spouse to understand her anxiety and stress, educated her on the patient care, and to give emotional support for relief of anxiety. The case manager also helped the patient's wife to seek family support to alleviate her burden and stress. When the patient completed his treatment, the case manager continued to provide care to the patient during the follow-up period through telephone contact to help him adapt to his new life after cancer treatment. The content of this paper presents the unique role of an oncology case manager. This nursing experience could be a model for interactions with patients of similar condition.

並列關鍵字

Rectal Cancer ； CCRT ； Case Manager