一位結直腸癌個案面對永久性腸造口及憂鬱症照顧者之照護經驗

A Colorectal Cancer Patient's Caring Experience by a Depressed Caregiver for Permanent Colostomy

吳靜華(Ching-Hua Wu) ； 吳美珠(Mei- Chu Wu) ； 劉錦茹(Chin-Ju Liu)

《安泰醫護雜誌》 25卷1期 (2019/06) Pp. 17-29

摘要

本篇描述一位初診斷結直腸癌個案，需面對術後永久性腸造口衝擊，及主要照顧者憂鬱症問題。筆者於2015年02月18日至3月2日護理期間。藉Gordon十一項功能性健康型態評估模式，確立個案有焦慮、身體心像紊亂、疲憊及主要照顧者有照顧者角色緊張等健康問題。利用會談引導個案說出內心對身體健康及手術威脅感受，並運用醫療團隊合作及音樂治療協助減輕焦慮感；運用正念減壓療法及腸造口模型輔助，使其接受永久性腸造口且重建正向自我概念，改善身體心像紊亂。促進個案了解癌性疲憊原因，鼓勵採能量保存法改善疲憊感。提供喘息服務資訊、協調家庭成員支持、照會癌症個管師、衛教手冊輔助說明及智慧型手機輔助教學，以減輕照顧者角色緊張。建議照護此類個案須依據其個別性，導入音樂治療、正念減壓療法及能量保存法等，協同各領域專家共同照護，以提供整合性照護。

關鍵字

結直腸癌 ； 永久性腸造口 ； 憂鬱症照顧者

並列摘要

This study is about the experience of a newly-diagnosed colorectal cancer patient who suffer the postoperative permanent colostomy and main caregiver caregiver with depression. Apply Gordon 11 Function Health Patterns from February, 18th to March, 3rd in 2015, it collected data of the patient's anxiety, fatigue and physical mental disorders, also show the main caregiver with tension condition. To interview and guide patient to express worries feelings, the medical teams use music therapy to release his anxious. The use of Mindfulness-based Stress Reduction and colostomy mold helped the patient to accept permanent colostomy and rebuild positive self-concept, which further improved the problems of body image disturbance. The patient was encouraged to understand the causes of cancer-related fatigue and use energy-conservation method to ameliorate fatigue to restore daily function. The information regarding respite care services, the coordination of family members' support, cancer-case manager's and ostomy specialist's notifications, and the subsidiary instructions for educational manual and smartphone help reduce caregiver's role-strain problems, thus promoting complete and continuous care for both the patient and the main caregiver. Final it provides the interdisciplinary team a care model, which not only apply music therapy, mindfulness-based stress reduction and energy conservation method to give integrated health care for similar patients.

並列關鍵字

colorectal cancer ； permanent colostomy ； depressed caregiver