乳房切除手術後之身體心像衝擊──以一位老年婦女為例

Restoring Body Image after Mastectomy:A Nursing Experience of an Elderly Woman

罹癌對人們是一種莫大的衝擊，尤其是乳癌婦女須接受全乳房切除後的身體外觀改變，但較少探討對老年婦女造成的衝擊。本文運用Watson關懷理論，強調人性關懷本質，協助一位接受乳房全切除的老年婦女，透過護病關係建立達到治療及照護目的。照顧期間自2013年8月30日至9月3日，藉由觀察、會談、身體評估、照護和家屬互動等方式收集資料，經分析後確立個案有「焦慮」、「身體心像紊亂」及「知識缺失」三項主要健康問題。筆者在護理期間與此接受全乳房切除的老年婦女建立良好護病關係，以同理傾聽和支持關懷協助個案表達感受並釐清疑問，更提供個案及家屬手術前後注意事項、術後復健及特殊內衣等資訊，使個案減輕焦慮及排斥感，進而適應外觀及生活習慣的改變。建議臨床護理人員照護此類老年患者時，可先建立良好護病信任關係，再給予老年病患身、心、社會的全人照護。

Cancer has a great impact on people’s lives, especially for woman with breast cancer and those who need to facethe changes of physical appearance after receiving mastectomy. The purpose of this case report was to assist an elderlywoman who received mastectomy using Watson’s caring theory, emphasizing the human caring nature throughestablishing a therapeutic relationship in order to achieve treatment and nursing goals. The nursing period was fromAugust 30 to September 3 in 2013. We used observation, therapeutic conversation, physical assessment, physical care,and family interaction to collect information. Through information collection and analysis, three major health problemsof this elderly woman were established including anxiety, disturbance of body image, and lack of knowledge. We usedempathetic listening and supportive caring based on well-established therapeutic relationship to assist this elderlywoman to express one’s feelings and clarify questions regarding the disease. Furthermore, we provided her and herfamily with the pre- and post- operation precautions, post-operative rehabilitation and special underwear and otherneeded information in order to alleviate her inner anxiety and sense of exclusion. Ultimately, this elderly woman couldadapt to changes in physical appearance and daily activities habits. Recommendations for future clinical nursing care ofsuch elderly patients can be first to establish a trust relationship, and then provide elderly patient with holistic carewhich consists of physical, psychological and social care of a whole person.