一位初次罹患口腔癌病人之個案管理照護經驗

Case Management Experience of Nursing Care for an Oral Cancer Patient

周玉書(Yu-Shu Chou) ； 徐莞雲(Wan-Yun Hsu)

《腫瘤護理雜誌》 16卷2期 (2016/12) Pp. 73-84

https://doi.org/10.3966/168395442016121602007

摘要

本文旨探討一位年輕男性因罹患口腔癌，接受根除性手術切除及游離皮瓣重建手術之護理經驗。個案於手術後，失去以往的開朗笑容，變得寡言、易怒，並拒絕旁人關心，家人對其感到擔憂與不知所措，故而引發筆者之動機，欲藉由提供相關護理措施，協助個案及家人因應疾病帶來的身、心困擾，以及增進術後自我照顧能力。個案照護期間自2013年7月19日至2013年7月31日，藉由觀察、會談、身體評估、查閱病歷及電話訪談等方式，進行主、客觀資料收集，並運用「羅氏適應模式」之概念架構進行評估，確立個案之護理問題為：知識缺失、急性疼痛及身體心像紊亂等健康問題。自初診斷、治療期間、到後續的追蹤期，筆者透過個案管理模式的介入，適時運用護理過程、溝通協調、病人及家屬的代言人、提供心理支持、妥善連結與整合醫療資源等，協助個案面對重大疾病之衝擊，以及調適因手術造成的生活改變，並進而引導其重新建立正向之身體心像，使其逐漸恢復原有的開朗與自信，並達到身心安適狀態。個案管理護理師如同初診斷癌症病人的領航員，除了與治療團隊成員溝通合作外，更需結合外部資源，提供個案與家屬協助，以達更專業之整體性照護。期望本個案照護經驗，能提供臨床護理人員照顧類似個案之參考。

關鍵字

個案管理 ； 口腔癌 ； 身體心像

並列摘要

This paper explores the nursing care experience of a young man with oral cancer. After the surgical eradication and free flap reconstruction surgery, patient lost his previous cheerful smiles and became reticent, irritable, and started to turn away from people. Seeing how his family members became worried and overwhelmed, the nurse decided to share her experiences to assist this patient and the family to face cancer and other related issues. From July 19, 2013 until July 31, 2013, the nurse collected subjective and objective data by observing, face-to-face interviews, physical assessment, medical records and telephone conversations, etc. Patient assessment done on the ＂Roy adaptation model＂ conceptual framework showed a lack of information, acute pain and body image disorders and other health problems. Intervention skills of the case management model had been applied from diagnosis, treatment to follow-up period such as the timely use of the nursing process, communication and coordination, patients and their families endorsement, proper use of medical resources, links and integration, psychological support, etc. Assistance was provided for the patient to help him face the impact of major diseases, adaptation to changes in life caused by surgery, and to guide him to re-establish the positive body image. Patient then gradually restored his smile in confidence, regained physical well-being and mental state. This clinical nursing experience shows that the case management nurse can serve as the navigator for cancer patients. Together with the treatment team members and external resources, they can provide timely assistance and in-depth multi-disciplinary holistic care to cancer patients at different stages of the disease.

並列關鍵字

case management ； oral cancer ； cancer

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