陪伴一位經歷全喉切除術患者之護理經驗

A Nursing Experience of Accompanying a Patient with Total Laryngectomy Surgery

本文描述一位歷經喉癌復發接受全喉切除的男性患者，因面臨溝通障礙與身體心像紊亂之護理經驗。筆者在2013年4月15日至5月10日照護期間，運用同理、關懷心與個案建立治療性人際關係，透過病歷查閱、觀察、筆談和家屬面談等方式收集主客觀資料，運用Gordon十一項健康功能型態評估，確立個案有「焦慮」、「言詞溝通障礙」、「身體心像紊亂」等健康問題。護理過程中，筆者擔任個案的代言人；運用跨領域團隊照護模式，緩解個案對手術過程及術後的壓力感受。另藉由成功案例的轉介，提振個案重建語言功能的信心，增加個案對氣管造瘻口的接受度；提升其自我照護能力，恢復與他人的社交互動。期望藉此經驗供臨床護理同仁參考，協助臨床類案都能順利度過人生中的難關。

This article described the nursing experience of a male patient who underwent total laryngectomy after the recurrence of laryngeal cancer, and suffered communication disorder and body image disturbance. During the nursing period from 15 April to 10 May, 2013, the Author built a therapeutic relationship with the patient through empathy and caring skills, collected subjective and objective information via medical record review, observation, written statements, and interviews with family members, and through the use of Gordon's 11 functional health pattern assessment tool, the following health problems were identified: anxiety, communication disorder, and body image disturbance. While serving as the spokesperson for the patient, the Author applied interdisciplinary team care model to relief the patient's anxiety regarding surgical procedure and postoperative stress; successful cases were referred to the patient to increase the patient's confidence in regaining speaking ability and hence the acceptance of tracheal stoma. By enhancing the patient's self-care ability, the patient regained social interactions with others. We hope that, by sharing this experience, it can serve as a reference for our clinical nursing colleagues to assist similar patients through difficult times.