運用羅氏適應模式照護一位孕婦合併乳癌之護理經驗

A Nursing Experience of Applying Roy's Adaptation Model to Aexpectant Mother with Breast Cancer

懷孕、生產、為人母是婦女生命週期中具有重要意義的歷程，在懷孕期間合併乳癌的發生，對婦女而言是一種莫大的衝擊，尤其乳癌婦女在面對乳房切除後身體外觀改變，對於婦女日後情緒的健康、母嬰關係有深遠的影響，並可能影響母性角色的發展與親子間的親密連結。本篇個案報告主要是探討一位懷孕期間罹患乳癌產婦的護理過程。護理期間為2015年11月14日至11月17日，護理過程中筆者運用羅氏適應模式加以評估，藉由觀察、陪伴、傾聽、會談等方式收集資料加以分析，確立護理問題有身體心像紊亂、焦慮、親職角色衝突。護理期間提供整體性、個別性之照護需求，並利用溝通技巧鼓勵個案表達其內心感受，鼓勵參加乳癌相關團體及宗教團體，改善身體心像紊亂；協助案夫一同參予及陪伴，減輕焦慮，提升自我及母職的自信心。建議各醫療院所應審慎思考針對此類個案的照護方式，並藉由產後肌膚接觸以及親子同室，達到親子親密的快速連結，及促進母性角色任務發展。 Pregnancy, giving birth, and being a mother are important events in a woman's lifetime. Thediscovery of breast cancer during pregnancy can be devastating, especially when facing the physicalchanges after a mastectomy as this may affect the woman's future emotional health, her role as a mother,and the mother-child bond. This report described the care provided to a woman who was diagnosed withbreast cancer during pregnancy. Care was provided from November 14, 2015 to November 17. Roy'sAdaptation Model of Nursing Care was used to evaluate the patient. Data were collected via observation,accompaniment, listening, and conversations. The analysis results confirmed that the patient had bodyimage disturbance, anxiety and parental role conflict. The author provided holistic and individual care andused communication skills to encourage the patients express herfeelings and join a breast cancer supportgroup and religious group to help restore her confidence toward body image. The patient's husband wasinstructed to accompany the patient to reduce anxiety and increase confidence. Healthcare providers arerecommended to carefully consider the care provided to this type of patient. Physical contact between themother and her baby and a shared hospital room environment can help quickly establish the mother-childbond and development of maternal role.