一位胃癌合併腹膜轉移病人首次化學治療之照護經驗

本文敘述一位胃癌合併腹膜轉移首次接受化學治療病人，護理期間自2018年6月8日至6月30日，經由會談、身體評估、觀察及直接照護等方式收集資料，運用Gordon十一項健康功能型態評估進行整體性評估及資料整合分析歸納，確立個案有營養少於身體需要、焦慮及無望感等健康問題。護理過程依個別性及喜好擬定營養計畫及監測飲食攝取量，維持基本身體代謝需求及提高免疫功能；醫療團隊運用醫病共享決策，瞭解個案內心感受及澄清其疑慮，使其減輕對化學治療的不安恐慌，進而降低焦慮不安情緒；透過良好的護病關係，協助其疾病適應及增強正向信念，降低罹癌衍生的無望感。建議醫療團隊除了緩解病人生理不適症狀外，更需重視病人身心需求及想法，早期介入處理個案的負向情緒反應，接受並同理焦慮不安感受，以正向心態面對疾病不可逆之事實，方可及早適應疾病及生活改變，以達身、心安適狀態，期望經此照護經驗分享，以供臨床實務參考之用。

關鍵字

胃癌；腹膜轉移；化學治療

並列摘要

This article describes the experience of nursing a patient with gastric cancer and peritoneal metastasis who was undergoing chemotherapy for the first time. The nursing care was performed during June 8-30, 2018. Data were collected through meetings, physiological assessments, observations, and direct care. The Gordon 11 Function Health Patterns was used for the overall assessment and data compilation, analysis, and deduction. The patient was confirmed to have the health problems of poor nutrition, anxiety, and a sense of hopelessness. During the nursing process, nutrition plans were personalized according to the patient's preferences and dietary intake was monitored to sustain the basic metabolic demand and boost the immune system. The medical team practiced shared decision-making between the patient and the team to understand the patient's feelings and to alleviate the doubts the patient had to reduce uneasiness and panic regarding chemotherapy, thereby reducing anxiety and feelings of uneasiness. By developing a strong nurse-patient relationship, the author assisted the patient in coping better with the disease and intensified the positive beliefs, thus reducing the sense of hopelessness the patient felt in relation to cancer. Author also suggested that medical teams not only alleviate patients' physiological discomfort but also heed their psychological needs and thoughts. Early intervention of patients' negative emotional responses, accepting and empathizing with patients' feelings of anxiety and uneasiness, and fostering patients' positive attitudes toward the irreversibility of the disease can help them coexist with the disease at an earlier time. Moreover, this will help patients to make subsequent life changes to achieve a state of physiological and psychological comfort. Author hopes that this nursing experience can serve as a reference for future clinical practices.

並列關鍵字

gastric cancer ； peritoneal metastasis ； chemotherapy

參考文獻

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一位胃癌合併腹膜轉移病人首次化學治療之照護經驗

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