一位大腸直腸癌篩檢陽性病患之護理經驗

Nursing Care Experience for a Patient with Positive Colorectal Cancer Screening

邱慧娟(Hui-Chuan Chiu) ； 林秀珍(Hsiu-Chen Lin) ； 陳麗琴(Li-Chin Chen) ； 陳淑卿(Shu-Ching Chen)

《腫瘤護理雜誌》 19卷增訂刊 (2019/03) Pp. 77-88

https://doi.org/10.6880/TJON.201903/SP_19.07

摘要

本文是運用跨理論模式照顧一位大腸直腸癌篩檢陽性病患之護理經驗。護理期間自2015年11月30日至12月28日，後續追蹤其大腸鏡檢查至2016年6月30日。運用Gordon十一項功能性健康評估，藉由整體性護理評估、觀察、會談等方式收集資料，確立健康問題為：大腸直腸癌及篩檢相關知識缺失、飲食中纖維攝取不足引起之便秘、及診斷期對疾病之未知引起之焦慮等健康問題。筆者於照護期間透過電話訪談、衛教手冊等方式，了解其不同的行為階段，運用不同的改變策略，提供大腸直腸疾病知識衛教，討論飲食計劃促進排便，澄清錯誤觀念緩解焦慮，以病患為中心之整體照護，使其最終達成行為改善之目標。希冀藉此護理經驗分享，提供臨床護理人員照護此類病患之參考。

關鍵字

跨理論模式 ； 大腸直腸癌 ； 癌症篩檢

並列摘要

This case report discusses the application of trans-theoretical model in the nursing care for a patient with positive colorectal cancer screening. The caring period was from November 30, 2015 to December 28, 2015, with a follow-up to June 30, 2016. The Gordon' eleven-functional assessment was used to assess nursing through holistic assessment, observation, and interviews. The nursing problems identified were insufficient knowledge on colorectal cancer screening, low-fiber diet related constipation, and anxiety during diagnosis. Nursing interventions included telephone interview and educational materials to help understand the different behavior stages, apply different strategies, provide the patient with colorectal cancer information, discuss diet plan, improve bowel movement, clarify misconceptions and palliative anxiety. Through the patient-centered holistic care approach, the author was able to help the patient make the desirable behavioral change. This experience could provide other nurses with a reference for future care of similar patients.

並列關鍵字

Trans-theoretical Model ； Colorectal Cancer ； Cancer Screening

參考文獻

沈珊如、汪慧鈴、王拔群、何雪華、陳靜敏（2009）．電話衛教計畫對冠心病高危險群防治之認知、健康信念及預防行為之改善成效．新臺北護理期刊，11（2），19-31。[Shan, S. J., Wang, H. L., Wang, P. C., Ho, H. W., & Chen, C. M. (2009). The effect of tele-phone education programs with telephone con-sultations on improving preventing knowledge, health beliefs, and behaviors among coronary artery disease high risk population. New Taipei Journal of Nursing, 11(2), 19-31.] doi:10.6540/NTJN.2009.2.003

徐莞雲、陳筱瑀（2008）．焦慮的概念分析．志為 護理，7（3），65-70。[Hsu, W. Y., & Chen, H. Y. (2008). A concept analysis of anx-iety. Tzu Chi Nursing Journal, 7(3), 65-70.] doi:10.6540/NTJN.2009.2.003

陳雅莉、林文娟（2016）．以整合照護指引與文獻回顧為基礎的老年人慢性便秘非藥物照護建議．台灣公共衛生雜誌，35（3），248-259。[Chen, Y. L., & Lin, W. C. (2016). Non-pharmacologic care for chronic constipa-tion in the elderly based on intergraded guide-lines and literature review. Taiwan Journal of Public Health, 35(3), 248-259.] doi:10.6288/TJPH201635104088

曾嘉慶、李嘉龍、吳啟華（2009）．大腸直腸腫瘤的篩檢與追蹤：文獻回顧與最新指引．內科學誌，20（6），506-513。[Tseng, C. C. Lee, C. L., & Wu, C. H. (2009). Screening and surveillance of colorectal neoplasm-review and update of guidelines. Journal of Internal Med-icine of Taiwan, 20(6), 506-513.] doi:10.6314/JIMT. 2009.20(6).05

張雅燕、謝曉燕、張嘉蘋（2011）．運用跨理論模式於一位心衰竭病患的飲食行為修正．新台北護理期刊，13（2），135-142。[Chang, Y. Y., Hsieh, H. Y., & Chang, J. P. (2011). Application of the transtheoretical model on eating behavior modification of a patient with congestive heart failure. New Taipei Journal of Nursing, 13(2), 135-142.] doi:10.6540 /NTJN.2011.2.014