運用通訊軟體照顧一位直腸癌病人適應腸造口之個案管理經驗

本文描述一位直腸癌個案，歷經反覆復發，術後需面對結腸造口帶來的身心衝擊及主要照顧者負荷問題，護理期間2018年11月26日到2019年1月12日，以Maslow需求理論，作為評估工具、透過面談觀察、電話訪問、門診追蹤，收集相關主客觀資料，確立個案健康問題有睡眠型態紊亂、身體心像改變、照顧者角色負荷，藉由模型實際操作示範、加深個案及家屬認識腸造口，進而主動學習腸造口相關照護技能及知識，逐漸接受身體心像的改變，過程中扮演傾聽、諮詢的角色，持續加強提供相關造口照護資訊，找出影響睡眠主因，透過門診面對面、電話訪問，輔以電子郵件及手機通訊軟體（Line），更製作造口教學影片，希望藉由掃描衛教單張上之二維條碼（QR code），增進居家照護技巧、主要照顧者信心、降低照顧負荷，提升日常生活品質，增加社交活動，建議未來可考慮如何將通訊軟體廣泛運用在病人照護上，維持連續、完整的諮詢管道，進而提升癌症照護品質之經驗分享。

關鍵字

直腸癌；腸造口；睡眠型態紊亂；身體心像改變；照顧者角色負荷

並列摘要

This article reported a nursing experience of a rectal cancer patient with repeated relapse, facing the physical and mental impact of colostomy, and discussed the burden of the primary caregiver. Nursing care was provided from November 26, 2018 to January 12, 2019. Maslow's hierarchy of needs theory was used as an assessment tool. Data was collected by observation, telephone interview, and outpatient track. The patient's health issues were sleep disorder, body image disturbance, and caregiver burden. By the model demonstration, the patient and the main caregiver could know more about the colostomy. Furthermore, they actively learned how to care for the colostomy and accepted the body image disturbance gradually. During the nursing period, the interventions were described as follows: utilizing E-mail, Line communication software, and colostomy care video by scanning QR code on health education leaflet. The author aimed to improve the home care skill of caregiver, build up the caregiver's confidence, decrease their burden, promote quality of life, and increase their social activities. Furthermore, how to apply communication software widely on patient care to keep continuous and complete consultation should be take into consideration. We hope this article could provide the care experience to promote the quality of cancer patient care and share the experience to other nursing staff.

並列關鍵字

rectal cancer ； colostomy ； sleep disorder ； body image disturbance ； burden of the primary caregiver

參考文獻

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