照顧一位子宮頸癌復發病人接受跨團隊手術之護理經驗

本文描述照護一位子宮頸癌病人因癌症復發，需決定是否行跨團隊婦科癌症手術及永久性腸造口和膀胱造口，及術後生理和心理轉變的護理經驗。照護期間從2017年3月13日至4月18日，運用Gordon十一項健康型態評估，以觀察、會談、身體評估等技巧收集資料，確立個案健康問題有營養狀況少於身體所需、抉擇衝突、疼痛及身體心像紊亂等，護理過程首先了解個案飲食習慣及喜好，以少量多餐方式，攝取高熱量、高蛋白及高維生素且易消化之食物來改善，增加攝取量；尊重個案及家屬對治療選擇，陪伴個案渡過抉擇的衝突期間；術後透過藥物與非藥物止痛措施來緩解個案的疼痛；面對術後無陰道及雙造口留置身體心像紊亂的問題以漸進式鼓勵病人表達對其外觀、結構及功能改變的看法，鼓勵病人正視及觸摸身體改變部位，並參與自我照護措施，另鼓勵參與支持團體，於活動中釋放負面情緒，減少心理困擾，學習正向心理調適，以改善生活品質。建議護理人員須培養高度敏感性，能正確的識別與評估病人生、心理所承受壓力，主動提供相關資訊及資源，以增添信念使其勇敢面對治療。

關鍵字

子宮頸癌；復發；抉擇衝突；跨團隊手術

並列摘要

This article was about a nursing experience of caring for a patient with recurrent cervical cancer, focusing on whether to receive cross-team a surgery of gynecological cancer and permanent colostomy and cystostomy and the patient's postoperative physiological and psychological changes. Inpatient nursing care was offered from March 13^(rd) to April 18^(th) in 2017. Based on Gordon's functional health assessment, the health problem of the case included malnutrition, conflict about decision making, pain, and body image disturbance. We understood the eating habits and preferences of the case, increased the patient's intake of high-calorie, high-protein, high-vitamin and digestible food in a small amount of meals, accompanied the patient to go through the conflict about decision making, gave post-operative pain control with pharmaceutical or non-pharmaceutical method, and encouraged the patient to face the body image disturbance about vaginectomy and double ostomies. A patient-supporting group was also established in order to release pressure, adjust negative emotion and improve quality of life. It is suggested that nursing members should be sensitive to identify patients' pressure physiologically and psychologically. Disease-related information and resources should be provided and give patients the faith to face the following treatments.