一位卵巢癌病人術後身心衝擊之照護經驗

本文為描述一位初次診斷卵巢癌末期接受手術治療之中年婦女，除需承受疾病治療及手術預後不確定感之身心衝擊外，因面對初診斷即為末期，無法接受罹癌事實而有焦慮、角色功能改變與個人因應失調等衝擊，引發筆者書寫動機。護理期間為2018年5月11日至5月25日，藉由觀察、傾聽、身體評估、會談及病歷查閱收集資料，以Gordon十一項健康功能評估工具，確立個案主要健康問題為急性疼痛、焦慮、身體心像改變、個人因應能力失調、潛在危險性跌倒、潛在危險性感染等。藉由束腹帶使用、放鬆技巧、音樂治療及按摩，以緩解疼痛；鼓勵參與卵巢癌病友會，分享抗癌心路歷程，以同理、關懷、陪伴，鼓勵表達感受，聯繫醫師召開病情討論會，以利接受身體心像改變之事實，並運用精油按摩及轉介諮商心理師，減輕焦慮，協助聯繫案姊以增強家庭支持系統。建議單位安排心理諮商相關在職教育，以提升護理人員心理層面照護知識、諮商技巧的運用及提升卵巢癌病人照護品質。並藉由跨領域團隊合作，協助個案渡過罹病初期之家庭衝擊及作為日後照顧此類病人之參考。

關鍵字

卵巢癌；身心衝擊；手術後照護

並列摘要

This article describes a caring experience of a middle-aged woman who was newly diagnosed with terminal stage of ovarian cancer and underwent surgery. In addition to the physical and psychological impact due to the uncertainty of treatments and outcomes, also found it hard to accept an initial diagnosis is already at the terminal stage of cancer. It encounters to the following health issues such as anxiety, ineffective role performance, and personal coping disorders; hence initiated the author's motivation to write. The period of nursing care was from May 11 to 25, 2018. Data were collected through observation, listening, physical examination, interviews, and medical history review according to Gordon's Functional Health Patterns Assessment; hence identified health issues of the case includes acute pain, anxiety, disturbed body image, personal adjustment disorder, hazard fall, and risk of infection. In order to relief pain, nursing care included access to abdominal binders, relaxation techniques, with music and massage therapy. In addition, encourage patient to participate in ovarian cancer support groups to share thoughts and experiences, providing empathy, caring, and accompany the patient to express her feelings; also to arrange the doctor to hold medical consultation, for patient's purpose of accepting the fact of body image change. Moreover, apply oil massage and counseling referrals to reduce anxiety and assist in contacting the patient's older sister to strengthen family support were also beneficial during care. This article recommends the unit to arrange the on-the-job training education in psychological counseling to escalate nurses' knowledge of psychological care and utilizing counseling skills to improve care quality among ovarian cancer patients. Finally, through cross-disciplinary teamwork, assist the case undergoing the family impact in the early stage of illness. Hopefully this nursing experience can serve as a reference in caring for similar patients in the future.

並列關鍵字

ovarian cancer ； psychological impact ； postoperative care

參考文獻

林宜欣（2020）．上皮性卵巢癌手術之後的更年期症狀與荷爾蒙補充治療．台灣更年期醫學會會訊，62 ， 14-19 。 https://doi.org/10.6651/TMS.202007_(62).02

林靜、林美惠（2018）．照顧一位卵巢癌末期個案之護理經驗．長庚護理， 29(2) ， 314-323 。https://doi.org/10.6386/CGN.201806_29(2).0014

施惠芬、陳妮婉、李欣怡、黃采薇（2018）．漸進式肌肉放鬆於癌症病患焦慮、憂鬱及噁心嘔吐之系統性文獻回顧及統合分析．澄清醫護管理雜誌，14(2)，40-49。https://doi.org/10.30156/CCMJ

張家語、謝春金（2017）．一位乳癌術後個案身體心像改變之護理經驗．高雄護理雜誌，34(3)，93-103 。 https://doi.org/10.6692/KJN.201712_34(3).0009

曾秀芬、劉千禎、林佩儀（2018）．一位初次診斷卵巢癌青少女接受化學治療之門診照護經驗．澄清醫護管理雜誌，14(4)，53-61。https://doi.org/10.30156/CCMJ

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