一位初知罹患結腸癌合併肝轉移病人之照護經驗

The Experience of Nursing a Patient Initially Aware of Diagnosis of Colon Cancer Combined with Liver Metastasis

韋岭岄(Line-Yueh Wei) ； 張乃文(Nai-Wen Chang)

《腫瘤護理雜誌》 18卷1期 (2018/06) Pp. 119-128

https://doi.org/10.3966/168395442018061801010

摘要

本文描述照顧一位71歲結腸癌病人合併肝轉移，接受化學治療過程中的身心調適，以及住院期間產生無望感和面臨家屬的緊張和無助的照護經驗。照護期間為2014年6月13日至2014年6月28日，筆者藉由觀察、會談、查閱病歷資料及身體評估等方式，並運用Gordon十一項健康功能型態評估收集資料，確立個案主要的健康問題為無法接受罹患大腸癌與疾病的預後不確定所產生的「無望感」，與初罹癌，疾病及治療資訊不足相關的「知識缺失」及不知道如何協助個案渡過治療期間的不適及不知如何自我心理調適的「主要照顧者角色緊張」等護理問題。藉由提供疾病、治療及照護相關知識，減少無望感及家屬的緊張；同時透過醫護人員及親友間鼓勵、支持及陪伴，重建希望及適應生活，共同面對後續的治療。希望此護理經驗能與護理同仁分享，同時提供未來照顧類似個案之參考。

關鍵字

結腸癌 ； 肝轉移 ； 照護經驗

並列摘要

This article describes the experience of nursing a 71- year- old patient who was suffering from the initial diagnosis of colon cancer combined with liver metastasis followed by chemotherapy. During hospitalization, patient faced physical and mental adjustment, hopelessness, family's tension and helplessness. Information regarding patient's health condition was collected through observation, interviews, review of the medical records, and physical assessment from June 13 to June 28, 2014. Gordon's 11 Functional Health Patterns was used to assess and identify patient's 3 major healthcare problems, which were hopelessness, deficient knowledge, and caregiver role strain. Nursing process consisted of providing the disease-related knowledge, information on chemotherapy and patient care skills of the caregiver, so that the patient's hopelessness and family's tension can be decreased, and the support and company can be encouraged to reconstruct hope to life adaptation. In so doing they could learn to face the subsequent treatments. The author would like to share this nursing experience with other nursing professionals.

並列關鍵字

colon cancer ； liver metastasis ； the experience of nursing

參考文獻

Davis, M. P., Lagman, R., Parala, A., Patel, C., Sanford, T., Fielding, F., ... Rybicki, L. A. (2017). Hope, symptoms, and palliative Care: Do symptoms influence hope? American Journal of Hospice and Palliative Care, 34(3), 223-232. doi:10.1177/1049909115627772

Dong, S. T., Butow, P. N., Tong, A., Agar, M., Boyle, F., Forster, B. C., ... Lovell, M. R. (2016). Patients’ experiences and perspectives of multiple concurrent symptoms in advanced cancer: A semi-structured interview study. Supportive Care in Cancer, 24(3), 1373-1386 1314p. doi: 10.1007/s00520-015-2913-4

Han, Y., Yuan, J., Luo, Z., Zhao, J., Wu, J., Liu, R., et al. (2013). Determinants of hopelessness and depression among Chinese hospitalized esophageal cancer patients and their family caregivers. Psycho-Oncology, 22, 2529-2536. doi:10.1002/pon.3315.

Heibl, C., Trommet, V., Burgstaller, S., Mayrbaeurl, B., Baldinger, C., Koplmuller, R., ... Thaler, J. (2010). Complications associated with the use of Port-a-Caths in patients with malignant or haematological disease: A single-centre prospective analysis. European Journal of Cancer Care, 19(5), 676-681. doi:10.66/j.1365-2354.2009.0615.x

Prouse, J. (2010). The impact of methods of information on chemotherapy-related side effects: A critical review. Clinical Journal of Oncology Nursing, 14(2), 206-26. doi:10.688/10.CJON.206-26