協助一位大腸直腸癌病人面對心理困擾之護理經驗

Nursing Experience for Assisting a Colorectal Cancer Patient to Reduce Psychological Distress

徐子婷(Tzu-Ting Hsu) ； 陳幼貴(Yu-Kuei Chen)

《臺大護理雜誌》 15卷2期 (2019/07) Pp. 159-171

https://doi.org/10.6740/NTUHJN.201907_15(2).0015

摘要

本文描述一位大腸直腸癌病人初診斷時逃避治療，採用民俗療法與服用中藥，此次因疾病進展就醫，個案對於接踵而來的感染、造口手術、化學及放射線等治療，身上有永久性腸造廔口及經皮腎造口引流管路，開始出現諸多疑惑及心理壓力，因而引發深入探討動機。於2016/6/15-7/10護理期間運用Gordon 11項健康型態評估，以觀察、查閱病歷、會談和直接照護等方法收集資料，主要有疼痛、身體心像紊亂、焦慮、無力感之健康問題，透過陪伴、傾聽及關懷與個案建立良好護病關係，整體性評估，運用藥物與非藥物方式進行疼痛控制，提供腸造廔口及經皮腎造口引流管路照護知識，協助修飾外觀，並引導個案正視自我身體外觀，提供疾病照護資訊及引導個案以階段性方式面對相關治療，以增加個案對疾病自我控制與治療的信心，參與相關照護，給予正向回饋。建議提早做好出院規劃，主動電話聯繫主要照顧照顧者，與其溝通並告知照護注意事項，以連結照護的完整性。

關鍵字

大腸直腸癌 ； 心理困擾

並列摘要

This article described a colorectal cancer patient who initially refused standard treatment and turned to folk treatments and traditional Chinese medicine. Later, the patient sought medical advice for disease progression. During hospitalization, the patient voiced feeling stressed about disease progression, colostomy, percutaneous nephrostomy (PCN), and the uncertainty of anticancer treatment. The nursing care period was from June 15 to July 10, 2016. We collected data using Gordon's 11 Functional Health Patterns assessment, observations, medical records, interviews, and nursing. Data were collected on pain levels, body image, feelings of powerlessness, and anxiety. By using the principles of accompanying, listening, and caring, we established a good relationship with the patient. We were able to provide information about colostomy and PCN, guided him to face his physical appearance and participate in related care, gave positive feedback to increase his self-control and confidence in the treatment of the disease, provided disease care information to clarify misconceptions, and guided the patient to face related treatments in a phased manner. We must take initiative in calling patient caregivers and giving them notes on discharge planning to ensure integrity of care.

並列關鍵字

colorectal cancer ； psychological distress