一位思覺失調症患者乳癌術後之護理經驗

Nursing Experience with a Schizophrenic Breast Cancer Patient after Mastectomy

本文運用認知治療改善一位46歲患有慢性思覺失調症個案，經歷乳癌術後的生活品質及心理健康之照護經驗。個案罹患思覺失調症超過24年，長期接受復健治療，因在例行健康檢查時發現乳癌，101年5月22日於地區醫院進行右側乳房切除手術，手術後返精神科急性病房住院。護理期間為101年5月30日至101年8月28日，藉由五大層面評估確立急性疼痛、身體心像紊亂、長期性低自尊三項護理問題。在傷口急性疼痛部份，透過建立信任的護病關係，同理內在感受，予傷口疼痛照護，個案自評傷口疼痛從10分降至4分；由於個案失去右側乳房而導致身體心像改變，藉由協助探索身體心像改變之感受，讓個案接受身體缺少乳房的事實；對於病人長期性低自尊護理問題，運用認知治療，改善負向的思考模式，個案變得開朗有笑容，生活依賴的問題也明顯改善。給予個別性的護理有助於精神病人走出乳癌術後傷口疼痛、身體心像改變、低自尊之陰霾。

This case study used cognitive therapy to improve the life quality of a 46-year-old woman with chronic schizophrenia who had undergone a mastectomy for breast cancer. This case had suffered from schizophrenia for over 24 years and was hospitalized in the chronic ward of our hospital. Breast cancer was revealed during an annual comprehensive physical checkup. In May 2012, this case received a right mastectomy at a local hospital. After the surgery, she was readmitted to the psychiatric acute ward for further care from May 30th to August 28th, 2012. A holistic nursing assessment was conducted that addressed five major aspects. The major nursing problems found during hospitalization were: acute pain, body image disturbance, and low self-esteem. A decline in pain score from 10 to 4 was achieved by developing rapport with the patient, empathizing with her distress, and providing active care to the wound. Her body image changed because of loosing her breast. Her acceptance of the loss improved through helping her to explore her feelings of change. To improve her self-esteem, we offered cognitive therapy to change her negative thinking process. She became more sanguine and cheerful. Moreover, her dependence in terms of activities of daily living decreased. This individualized intervention contributed to the recovery of a post-mastectomy, schizophrenic patient from low self-esteem.