照顧一位接受高劑量率後荷式近接治療之前列腺癌病患的護理經驗

Experience of Nursing Care for a Prostate Cancer Patient with High Dose Rate Brachytherapy

本文乃是探討照顧一位侷限性前列腺癌個案，經歷高劑量率後荷式近接療程的護理經驗。高劑量率後荷式近接治療有別於傳統體外放射線治療及一般近接治療，其能在放射線治療時，直接將高劑量的放射線射源伸入前列腺中，治療完畢便移出前列腺，減少周邊組織所受到的放射線傷害。但為了避免治療期間近接治療針移位，病患必須維持雙腿外展、屈膝仰臥及臀部稍微墊高的姿勢，長達36小時之久。也因此造成許多病患腰酸、背痛等不適的症狀。本文描述護理人員運用適當的溝通技巧，於住院期間與個案建立良好的治療性關係；並且依據Gordon十一項健康評估，確定了個案有急迫性尿失禁、潛在危險性廢用症候群及恐懼等健康護理問題；同時也擬定了護理計畫及提供適當的護理照護，使個案身心更健康；這其中包括了背臀部按摩及翻身來緩解臥床36小時的腰酸背痛、透過反覆的衛教來增進個案對疾病的認知及自我照顧的能力、藉由深呼吸運動及支持系統來緩解害怕的情緒等。期望此經驗能提供臨床護理人員在照顧此類病患的參考，以提升此類病患的照護品質。

The purpose of this article was to describe the experiences of nursing care for a prostate cancer patient under high dose rate brachytherapy (HDR). The advantage of HDR is the ability to deliver higher dose radiation directly to the tumor while sparing healthy tissue and surrounding organs. Once the temporary radioactive source is removed, there is no remaining radioactivity. In order to keep the tips of HDR needles within the prostate, patients must maintain a supine position with abduction of bilateral hips, flexion of bilateral knees, and mild elevation of buttock for 36 hours. Some patients complain about back pain, numbness, and discomfort caused by this specific posture. This article described the nursing experiences such as establishing therapeutic relationship, assessing patient’s condition by the Gordon functional health assessment tool, identifying nursing problems encountered by the patient, and implementing adequate nursing activities. Three nursing problems were: urge urinary incontinence, risk for disuse syndrome, and fear. Nursing activities implemented were: back-massage and change position to relieve back pain caused by restrictive positioning for 36 hours; providing health education to improve knowledge and self-care capacity of patient, training the patient to perform breathing exercise and utilizing his social support system to reduce the fear experienced by the patient. It is a frame of reference while the nurses take care of patients under similar treatment, thus, quality of care of these patients can be improved.