運用羅氏適應模式照護一位肝癌復發術後病人之護理經驗

A Nursing Experience by Applying the Roy's Adaptation Model for a Patient after Liver Cancer Recurrence

蔡嘉慧(Jia-Huei Tsai) ； 陳俞君(Yu-Chun Chen)

《彰化護理》 28卷4期 (2021/12) Pp. 93-106

https://doi.org/10.6647/CN.202112_28(4).0012

摘要

本文為照顧一位肝癌接受放射頻燒灼術後，因面臨突如其來的疾病復發衝擊，進而對未來癌症疾病進展感到不確定感之護理經驗。於照護期間2019年04月14日至04月20日運用羅氏適應模式進行評估，採觀察、傾聽、筆談及身體評估等方式收集資料，確立個案有急性疼痛、不確定感、個人因應能力失調等健康問題，於照護過程中藉由藥物及非物理性之個別性技巧以緩解傷口疼痛之不適，提供疾病相關訊息以利釐清，給予正向支持以降低負向情緒思考，透過個別化衛教指導，增進個案自我照顧及調適能力，以達整體性照護品質。建議可建置團隊相關溝通平台，以利醫療團隊於病人住院時，能即時了解病人罹癌與治療期間之心路歷程與擔憂，能更快速且明確掌握病人整體狀態，以達到全人整合醫療照護品質。

關鍵字

羅氏適應模式 ； 肝癌 ； 復發 ； 不確定感

並列摘要

The article is going to describe a nursing experience of a patient who suffered an unexpected relapse and feels struggled with the future after received RFA (Radiofrequency Ablation) to treat a liver tumor. In the period of nursing care from April 14 to April 20 in 2019, the author doing evaluations with Roy's adaptation model and collected data through the methods of observation, listening, advisory, physical examinations, and so on. After a series of assessments, the diagnosis revealed the patient has multiple health issues which included acute pain, uncertainty, ineffective individual coping, and so forth. During the nursing process, the author decided to ameliorate the problems according to the therapeutics as follows:1. Eased the wound pain and discomfort by medicine and non-physical individuality skill treatment. 2. Provided relevant information about the disease for better clarification and explanation to the patient. 3. Expressed positive encouragement and active support properly to the patient and therefore relieved any negative emotion or thinking. 4. Arranged professionals to instruct with individualizing health education guidance, which can effectively improve the patient's ability of self-care and adaptability to reach integrity nursing quality. To satisfy holistic health care and maintain the medical nursing quality, the author suggests setting a platform for team communication. While the patients are hospitalized, the platform can instantly benefit the medical team by acquiring the patient's concerns and internal struggle from disease confirmation to the period of therapy. Furthermore, the medical team can also master the patient's overall situation more quickly and precisely.

並列關鍵字

Roy's adaptation model ； hepatocellular carcinoma ； recurrent ； uncertainty

參考文獻

朱怡瑾、劉曼盈、胡嘉桂、蘇家慧、陳姿蓉、陳俏潓、吳麗敏（2018）‧不確定感之概念分析‧高雄護理雜誌，35（2），53-60。

呂宜佩、陳筱玲（2014）‧應用紐曼模式於一位復發性肝癌病患接受再次手術治療之護理經驗‧彰化護理，21（1），50-59。

呂欣衿、邱存梅、王斐雯（2016）‧運用跨理論模式提升護理人員對重症病人疼痛評估處置完整性‧長庚護理，27（3），353-367。

徐友春（2017）‧認識肝癌及肝硬化‧血管醫學防治季刊，（28），8-9。

郭瑞萍、翁靜美、陳金玫（2015）‧護理人員在術後疼痛照護中的挑戰‧領導護理，16（4），11-20。