照護一位行人造新膀胱重建手術女性病人之護理經驗

Nursing Care Experience of Female Patient Receiving Neobladder Reconstruction

陳安廷(An-Ting Chen) ； 楊舜璇(Shun-Hsuan Yang) ； 黃嗣棻(Szu-Fen Huang)

《臺大護理雜誌》 16卷2期 (2020/07) Pp. 64-75

https://doi.org/10.6740/NTUHJN.202007_16(2).0007

摘要

本文旨在探討一位女性，因罹患膀胱尿路上皮癌並接受人造新膀胱重建手術，所經歷的衝擊與調適過程之護理經驗。個案因術後恢復未如預期能保有正常外觀出現負面情緒，主因擔心膀胱造瘻管路留置影響與案夫的親密關係，而引發探討動機。於2017年7月10日至8月26日護理期間，藉由直接護理，並運用會談、觀察、身體評估及病歷閱讀等方法，以Gordon 11項功能性健康型態作為評估指引，確立個案主要有焦慮、急性疼痛及身體心像紊亂等健康問題。護理期間運用傾聽及同理心，與其建立良好治療性人際關係，同時也鼓勵案夫參與照護計畫，討論並澄清手術後可能發生的性生活問題，協助建立信心及正確性觀念，緩解擔心手術及排尿型態改變對性生活影響的焦慮；術後急性疼痛，除了給予藥物控制，透過指導深呼吸、聆聽音樂等，有效維持生理舒適；並提供具個別性的照護，引導個案重新接納自我，正向面對疾病所帶來的衝擊，使其出院後能維持夫妻親密關係並享有良好生活品質。經由此次護理經驗，建議在門診設立「性衛教諮詢室」，由專業心理師或膀胱癌個管師提供諮詢，讓病人獲得更完善的癌症醫療照護，期望藉由此次護理經驗的分享，做為日後臨床照護之參考。

關鍵字

膀胱癌 ； 人造新膀胱 ； 身心困擾

並列摘要

This case study described the nursing care experience of a women's psychological adaptation process after receiving radical cystectomy and neobladder reconstruction for bladder cancer. The patient appeared emotional distress after the reconstruction because she was afraid that the cystostomy would affect sexual life and intimacy with her husband. According to the guide of the Gordon 11 functional health pattern, her health problems including anxiety, acute pain, and body image disturbance were confirmed after comprehensive nursing assessments through direct nursing care, face-to-face interviews, observations, physical examination, collecting data from medical chart from July 10 to August 26, 2017. Through providing empathy and active listening, a therapeutic relationship was established. To relief anxiety about the changes of sexual life, we encouraged her husband to join the care together with the patient and discussed with them to clarify the questions regarding sexual problems after surgery. About the non-medication intervention for acute pain control, we taught the patient learning about deep breath exercise and listen to music. We provided psychoeducation aiming to accept self, reduce fear about disease, and maintain her sexual life after being discharged from the hospital. Based on this nursing care experience, the psychologist's and case manager's consultation for sexual problems after bladder cancer treatments at the outpatient department is recommended to provide the more comprehensive cancer care. We hope this nursing care experience can enhance clinical nursing care for bladder cancer women.

並列關鍵字

bladder cancer ； neobladder reconstruction ； physical and mental distress