一位頰膜癌患者住院期間之身體心像改變及因應行為

The Altered Body Image and Coping Behavior of a Patient With Buccal Cancer

本個案研究乃探討一位頰膜癌患者住院期間之身體心像改變及其因應行為，以協助患者渡過因手術帶來的 身體心像重建壓力，故釐清及了解患者如何面對身體心像之改變及所採取之因應行為，將是本個案研究的主要目的。護理期間自91年10月14日至91年11月13日，運用觀察及會談及身體評估等技巧收集資料，將護理 過程寫成十三篇行為過程記錄，經資料整理及分析歸類，個案身體心像改變分別呈現於身體結構、身體功能、 身體感覺及社會功能等四方面。面對這些身體心像改變，個案不斷運用自己的調適系統，由初期的情緒取向如抒發情緒、降低生理需求、社交退縮，到後來的問題因應如不斷運用主動詢問求得解答、主動參與治療、發展正向的身體心像及走出病室面對他人。筆者在照護過程中，運用同理心、傾聽、主動關懷等支持技巧和患者、 家屬建立良好的治療性人際關係，積極處理患者生理上的不適，協助個案進行正向調適，加強個案面對疾病的自信心、試著尋求協助、積極參與護理活動，終能使患者重拾信心順利出院。藉此護理經驗之分享，期能提供護理人員曰後照護此類患者之參考，進而幫助病患適應與接受自我的改變以早曰恢復曰常生活與自信。This case study explored the altered body image and coping behaviors of a hospitalized patient with buccal cancer. Helping a patient overcome the stress of body image reconstruction due to surgery is a topic of great importance. The purpose of the study was to clarify and understand the patient’s coping behaviors, and how he faced the altered body image.Data were collected through observations , discussion, communication and physical evaluation skills from Oct. 14 2002 to Nov. 13 2002.Thirteen records of nursing process were completed and the contents were analyzed inductively.The alterations of body image in this case were categorized into four domains: body structure, body function, body sensation and social function.He adjusted himself to cope with the stress.The processes of his adaptation included negative emotional expression, resumption of physiological demands, and withdrawal 。 Next, the patient demonstrated positive coping behavior such as asking, attending the treatment actively, adapting a positive body image and, in the end, facing others. Empathy, listening and active caring were applied to the patient The nurse built up a good relationship with the patient and his family.The author also actively cared for the patient’s discomfort, helped the patient to adjust positively, and enforced confidence in confronting the disease. By seeking help and actively participating in the nursing activity, finally, the patient was discharged without fear .This report provides nurses with a reference for caring for similar patients in the future, and helping the patients to accept themselves and return to their normal life.