一位喝清潔劑自殺後行空腸造口術乳癌患者之護理經驗

本文描述一位行過多次化學治療待手術之乳癌患者，吞食清潔劑自殺後，食道大面積灼傷而行空腸造口術治療過程中，引起的身心反應及面臨壓力之護理經驗。護理期間自民國106年6月24日至106年7月15日，藉由觀察、會談、傾聽溝通與身體評估方式，收集生理、心理、社會與靈性各層面資料，以Watson人性關懷理論為架構，確立個案有組織灌流改變-腸胃、營養狀況改變-少於身體需要、疼痛及無望感等健康問題。筆者藉由良好的護病關係，提供病人接受空腸造口術之術前相關資訊及護理指導，並於術後提供緩解傷口疼痛的護理技巧及滿足生理需要的營養需求等護理照護，另應用人性關懷理論協助個案渡過無望感的危機，重建自我價值與希望，出院前教導個案及家屬傷口照護及灌食技巧，改善自我照顧能力及增進家庭關係。建議癌症病人確診初期醫療團隊應加強心理關懷，使其適應身心狀態的變化，以正向態度積極治療、迎接未來。期盼藉此護理經驗提供其他護理人員照護上的參考。

關鍵字

Watson關懷理論；自殺；無望感；空腸造口術

並列摘要

This article describes a nursing experience in a breast cancer patient's physical and mental reactions and stressful care who has post multiple chemotherapies and wait to be surgical, swallowed detergents suicide, and due to large area of esophageal bums, this patient operated jejunostomy. Nursing period from June 24, 106 to July 15, 106, collecting information of various levels of physiology, psychology, society and spirituality through observation, talks, listening and communication and body assessment methods. Based on Watson's theory of human care, we established that there was a change in organizational perfusion of stomach, a change in the state of the nutrition less than physical problems, pain and hopelessness. The author uses a good relationship between nurses and patients to provide jejunostomy preoperative information and nursing guidance, and to provide postoperative nursing care skills to relief the wound pain and nutritional needs to meet the physical needs... etc. In addition, using the theory of human care to help the patient to cross the hopeless crisis and rebuild them own values and hopes. And also giving pre-discharge teaching of case and family about wound care and feeding skills, improvement of self-care skills and promotion of family relations. Our recommend is for patients who newly diagnosed with cancer, the medical team should strengthen psychological care to make them adapt the change of the body, and using positive attitude to receive treatment and a bright future. We look forward to using this nursing experience to provide reference for the care of other nurses.

並列關鍵字

Watson's theory ； suicide ； Hopelessness ； jejunostomy

參考文獻

林帛賢、李明濱、陳宜明、廖士程(2013)‧癌症病患之自殺防治‧台灣醫學，17(2)，163-170。

陳曉琦、周汎澔(2010)‧Watson人性化關懷照護理論與Swanson關懷照護理論之比較‧護理雜誌，57(3)，86-92。

Liao, K. Y-H., Yeung, N. C-Y., Wong, C-C. Y., Warmoth, K., & Lu, Q. (2017). Fear of cancer recurrence and physical well-being among Chinese cancer survivors: the role of conscientiousness, positive reappraisal and hopelessness.Support Care Cancer , 25(4),1141–1149.

Toussaint, E., Gossum, A.V., Ballarin, A., & Arvanitakis, M. (2015). Enteral access in adults. Clinical Nutrition, 34(3), 350-358.

許瑋倫、李宏昌(2011) ‧腐蝕性食道炎‧當代醫學，455，678-680。