一位口腔癌患者術後身體心像改變之加護經驗

An Intensive Care Experience: An Oral Cancer Patient with Postoperative Body Image Change

本文描述一位罹患口腔癌的男性患者，面對手術後所造成衝擊之護理經驗。護理期間自2014年2月6日至2月12日，藉由觀察、筆談、身體評估、查閱病歷及直接照護等方式收集資料，運用羅氏適應理論為工具進行整體性評估，確立個案有呼吸道清除功能失效、急性疼痛、口腔黏膜障礙及身體心像改變等健康問題。護理過程中藉由主動關懷及陪伴，與個案建立信任之護病關係，提供個別性與整體性的專業照護，包括提供胸腔物理治療及教導正確腹式深呼吸、咳嗽方法，幫助個案有效排出痰液；運用放鬆技巧、維持舒適臥位，減輕術後傷口疼痛；加強口腔護理以促進傷口癒合及患者舒適；並透過治療性關係建立，鼓勵表達術後身體心像改變之內心感受，使個案能接受並面對身體外觀改變的事實，重新肯定自我價值。

This article is primarily on the nursing experience of an oral cancer patient facing body image disturbance after surgery. Data were collected from February 6 to 12, 2014, through observation, written communication, physical assessment, case history assessment, and direct care. By using Roy’s adaptation theory a tool of comprehensive assessment, the patient was found with ineffective airway clearance, acute pain, impaired oral mucous membrane, and body image disturbance. Through proactive care and companionship during the nursing process, a trusting nurse-patient relationship was established; individualized and comprehensive care were provided, including chest physiotherapy and diaphragmatic breathing lessons, to effectively enhance sputum clearance; relaxing technique and comfortable prone position were taught and maintained to reduce postoperative pain; enhance oral care ti facilitate wound healing and patient comfort; and therapeutic relationship was established to encourage the patient’s emotion expression on postoperative body image disturbance, which allowed the patient to accept the altered body image and reaffirm self-worth.