糖尿病合併胰臟癌患者術後回復身體活動功能之照護經驗

Care Plan for Resuming the Physical Activity of Patients With Pancreatic Cancer and Diabetes After Surgery

癌症術後常帶來多種阻礙而影響身體活動，儘早制訂訓練計畫能協助病人恢復及維持身體功能狀態，將減輕家屬照顧負擔，然而臨床護理人員卻較少運用相關指引給予術後身體活動具體建議及照護。筆者於照護糖尿病合併胰臟癌個案術後期間，透過運用2016年美國國家癌症資訊網（National Comprehensive Cancer Network, NCCN）「癌症存活者—健康生活型態之身體活動指引」，進行個案臨床身體狀態、可治療因素、影響其執行身體活動之障礙因素以及身體活動風險程度評估，依評估結果擬定符合其需求的計畫，給予糖尿病患者活動之建議，進行身體活動訓練；並提供均衡營養攝取，避免營養不足成為身體活動執行障礙，且結合糖尿病注意事項之相關衛教於術後照護中，以增進自我照顧能力；同時鼓勵家屬共同參與，給予個案心理支持與促進其執行意願，協助盡快回復身體活動功能，進而提升生活品質。期望透過此文將此指引提供護理人員於照護相關類型病人期間，進行身體活動訓練之參考。

Many barriers influence the ability of postoperative cancer patients to reengage in normal physical activities. Training programs have been shown to be effective in helping restore physical activity in patients and in reducing the care burdens of family members. Nurses cannot use physical activity guidelines in their care plan to assess individual needs. The clinical practice guidelines for physical activity in survivorship were published by the National Comprehensive Cancer Network (NCCN) in 2016. These guidelines are used to assess patients' physical status, curable factors, physical barriers, and risk of postoperative pancreatic cancer and diabetes. In line with this assessment tool, the physical activity guidelines, and the recommendations for cancer patients, the authors planned a physical activity training program that addressed the actual needs of patients under their care. Further, the authors provided special notes for a diabetic diet that helped reduce the barriers to resuming physical activity and enhanced independent care efficacy. Meanwhile, the authors encouraged family members to participate in patient-care activities and family mental-health support and to promote patient participation in the training program in order to increase quality of life. The present project demonstrates that this care plan may provide an effective guide for nurses to help other cancer patients resume physical activity.