一位行迴腸導管手術病患身體心像紊亂之護理經驗

A Case of Patient Body Image Disturbance after Ileal Conduit Operation- From the Nursing Care Point of View

本文旨在探討一位膀胱癌之患者，因經歷迴腸導管手術導致身體外觀改變，所面臨的身、心衝擊與調適過程。筆者於2006年2月22日至3月8日的護理期間，應用Gordon十一項功能性健康型態評估工具，並藉由觀察、會談、身體評估及直接護理等方式，收集主、客觀資料，確立個案有：「身體心像紊亂」、「危險性皮膚完整性受損」、「危險性創傷」、「健康維護能力改變」等護理問題。在護理過程中與病患及家屬建立良好的護病關係，運用傾聽、陪伴、心理支持、教導、回覆示教等護理技巧，並鼓勵家屬參與互動，協助個案接受自我身體心像改變，及增加其自我健康維護能力，使個案重新面對自我，減少其心理衝擊，進而面對出院後的生活。筆者身為泌尿科護理人員，在臨床上看到膀胱癌的病患雖然因醫學的進步提高了存活率，但行尿路改道術的病患，則必須面對永久性造瘻口，其對於自我身體心像改變之心理及社會的衝擊，卻遠大於手術本身的損傷，故筆者期望藉此護理經驗的分享，使護理人員對照顧此類病患時，能有更深的認識，進而提升護理照護的品質，讓病患具更正向的疾病適應。

This paper explored the process of physical and psychological adjustments a patient due to the impact of physical changes to the patient’s body after an Ileal conduit procedure. From February 22nd to March 8th, 2006, the author applied the Gordon’s assessment tool. Through observation, consultation, body evaluation, and direct nursing care, the author collected objective and subjective data and identified that the case subject exhibited problems such as “Body Image Disturbance”, “Risk for Impaired skin integrity”, “Risk for Trauma” and “Altered Health Maintenance.” Throughout the caring process, the patient and the family had built an excellent nursing care relationship by listening, accompanying, emotional support, teaching, and correspondence. In additional, the family was encouraged to participate, in order to assist the patient to accept the changes to self body image and to enhance the patient’s ability to self-care. These strategies allowed the patient to be able to face the new self, and to reduce the psychological impact. The methods further strengthened the patient’s ability to adjust to the life after discharge. This experience provides nursing staffs with further understanding of the patient and improves the quality of care.