一位直腸癌末併發嚴重腹瀉患者之調適過程

The Process of Adaptation in a Patient with Terminal Rectal Adenocarcinoma Complicated with Severe Diarrhea

本文描述一位58歲直腸癌末期女性患者，面對身體、心理、社會層面受損之護理經驗。筆者自92年2月9日至92年3月2日照護期間，運用羅氏適應模式為評估架構，發現個案有腹瀉、身體心像紊亂和無力感護理問題。筆者給予整體性照護、持續同理心關懷，增加護病關係，協同醫療團隊的合作；聯繫病友團體的支持和靈性的力量，減緩個案腹瀉頻率，增加正向的身體心像行為，減少無力感達到心理調適，提昇個案生活品質。期望藉此護理經驗，提供臨床護理同仁照顧此類病患之參考。

This article documented the experience of nursing care for a fifty-eight years old female with terminal rectal adenocarcinoma and suggests how to overcome the patient’s physical, psychological and social difficulties. A systemic evaluation using Roy's adaptation model was performed during the caring period from 9th February to 2nd March in 2003 and several problems were identified including diarrhea, a disordered body image and a feeling of powerlessness. During the nursing period, the author used empathy and acceptance by the patient to build up a good nurse-patient relationship in order to provide appropriate and continuing nursing care. This involved areas such as cooperating with the medical team, making contact with similar patients and spiritual empowerment. These approaches decreased the patient’s frequency of diarrhea, made a positive adaptation possible, reduced her feeling of powerlessness, helped her to adapt to the disease’s physical and mental impacts and raised her quality of life. We hope this nursing experience will help the provision of care to similar patients in the future.