一位乳癌末期患者心路歷程改變之護理經驗

Nursing Experience with a Patient SufferingPsychological Changes During the Terminal Phase of Breast Cancer

本篇文章筆者利用羅氏適應模式理論，探討一位乳癌末期婦女於住院期間心路歷程改變的護理經驗。自92年8月26日至92年9月16日護理期間，以羅氏適應模式之生理功能、自我概念、角色功能、相互依賴四種適應導向的護理概念架構作評估，分析出個案三個主要問題為：焦慮、身體心像紊亂、無力感等護理問題。針對個案擬定個別性護理計劃，藉由教導個案使用漸進式肌肉放鬆技巧減輕焦慮；引導個案說出自己對疾病所產生疑問，及身體傷口對自己的影響，並與個案共同討論找出最適合自己的改善方法，以增進個案的自信心，自我心像建立，進而願意面對人群，參與社交互動，使其在癌症末期的日子有最佳的適應情形，進而改善生活品質。

The writer applied Roy’s adaptation theory to discuss the psychological changes that a female hospitalized patient suffered during the terminal phase of breast cancer. From August 26, 2003 to September 16, 2003, the Roy’s adaptation model guided the assessment of the psychological changes associated with the terminal phase of the patient’s breast cancer. There were three major adaptation problems: anxiety, body confusion and helplessness. To alleviate these problems, we decided to implement an individualized nursing plan: we taught the patient to relax her muscles step by step to ease away her anxiety; we encouraged her to talk about her illness and whatever problems she was encountering so that she could understand how the disease and surgery had affected her; we discussed with the patient what would be the best way to help her to relieve her discomfort. By implementing the above steps the patient became more confident and was able to improve her self-image. Subsequently, she was more willing to face the people around her and take part in social settings, which made adaptation to her quality of life during the terminal phase of her illness better and easier.