一位膽管癌患者行化學治療合併情緒困擾之照護經驗

A Nursing Experience of a Cholangiocarcinoma Patient Undergoing Chemotherapy with Emotional Distress

本文為一位初診斷膽管癌患者接受化學治療時承受疼痛與焦慮、害怕及擔心等情緒困擾的護理經驗。2012年12月8日至2013年1月7日照護期間，筆者以直接照護、觀察、訪談、團隊討論及出院後電訪等方式收集資料，運用Gordon十一項健康功能型態評估，確立護理問題為：疼痛、情緒困擾、管路照護技能不足。筆者以主動關懷、同理心等技巧，提供持續性護理與諮詢，擔任醫師與個案間溝通橋梁，協助疼痛症狀獲得良好控制；幫助個案對病程及化學治療的了解，並鼓勵家屬全程參與照護計劃，讓個案受衝擊的情感獲得宣洩，達到情緒調節，進而主動參與自我照護；更提供管路相關護理指導，以提升其返家後自我照顧之生活品質。希望藉此提供護理人員參考。

This article described the nursing experience of a male patient diagnosed with cholangiocarcinoma who underwent chemotherapy and suffered pain and emotional distress such as anxiety, fear, and agitation. Between December 8, 2012 and January 7, 2013, the author collected data through direct care, observations, interviews, team discussions, and phone interviews using Gordon's 11 Functional Health Patterns. The patient was identified with the following nursing issues: pain, emotional distress, and inadequate tube care skills. The author provided continuous care and counseling with active care and empathy, and acted as a liaison between the physician and the patient to assist with pain management. The author explained to the patient the course of the disease and chemotherapy to the patient, and encouraged the family members to participate fully in the care plan, to create an emotional release for the distraught patient, and encourages the patient to engage in emotion regulation, and actively participate in self-care. The author also provided nursing instructions on the peripherally inserted central catheter, which improved the patient's quality of life in self-care after discharge. This nursing experience can serve as a model reference for all nursing staff when attending to similar cases.