運用Orem理論照護潰瘍性結腸炎患者接受迴腸造口之護理經驗

The Nursing Experience of Applying Orem Theory to Care an Ulcerative Colitis Patient with Ileostomy

腸造口對病患而言不只是身體上的新構造，也威脅到病患以往對身體的整體概念，無預期性的腸造口手術往往使個案及家人措手不及，無論在身、心、靈各方面皆造成莫大的影響。本文主要在描述一位罹患潰瘍性結腸炎之患者，接受全結腸切除及迴腸與肛門吻合術，術後因吻合處滲漏進而接受迴腸造口所引發之身、心、靈等種種衝擊。護理期間為2008年10月12日至11月24日，筆者以Orem理論為評估架構，採觀察、傾聽、會談等方式收集資料，確立個案的護理問題如下：疼痛、營養不均衡；少於身體所需、皮膚完整性受損、身體心像紊亂、社交隔離。經由與個案及家屬建立良好的護病關係，共同擬定並執行具個別性的護理措施，筆者協助個案學習迴腸造口的自我照顧技巧，且成功地協調個案面對疾病過程及身體外觀的改變，回復原有之社交生活進而提昇生活品質。期以本文與護理同仁分享無預期性腸造口術後所引發之併發症等照護經驗。

Ileostomy not only changes body’s structure, but also threats the body image of an individual. Undergoing an unexpected ileostomy has dramatic impact on physical, psychological, and mental health of an individual and his or her family. This paper presents a patient receiving ileostomy and encountering problems after the surgery. Nursing care period was from October 12, 2008 to November 24, 2008. Using Orem theory as an assessment tool, several nursing problems were identified. They included pain, imbalanced nutrition: less than body requirement, impaired skin integrity, disturbed body image, and social isolation. Good therapeutic relationships were established and individualized care was provided. The patient successfully learned ileostomy wound care, faced disease process, accepted change of his body image, and re-established normal social life. We hope this paper provides useful resources to our colleagues when caring patients with similar conditions.