照護一位大腸癌併腹膜假性黏液瘤長者無望感之護理經驗

A Nursing Experience of Caring an Elderly Patient with Colorectal Cancer and Peritoneal Pseudomyxoma with Hopeless Using Gordon's Functional Health Theory

本篇報告在探討一位73歲長者，在治療大腸癌症期間又再次併發罕見的腹膜假性黏液瘤，在面對雙重癌症的衝擊下，造成生理上的不適及面對疾病未來產生無望感的照護過程。照護期間為2016年2月1日至2016年2月15日止共計15天，運用Gordon十一項功能性健康型態評估及身體評估、觀察、親身訪談、病歷查詢等方式收集病人相關資料，確立其主要護理問題為：無望感、組織灌流失效／腸胃及身體心像改變。在照護過程中，藉由建立良好護病關係，引導病人尋找現在與未來存在的意義，以接受疾病進展所帶來的改變，降低對未來的無望感；並提供飲食技巧，設計數據紀錄本並教導相關評估技術，進一步訓練家屬可說出並執行當出現何種徵象及症狀時，病人必須至醫院接受醫療處置的時機，以改善腸胃道組織灌流失效的症狀，提高身體的舒適感；且當引導病人說出自我內心感受及需求後，醫療團隊與家屬間共同擬定照護計畫並實施，讓病人能面對並接受自身身體外觀的改變，進而維持其生活品質。期望藉由此篇報告，在照護過程中，能運用全人理念，了解病人感受，及全家的支持及全隊的照護方式，整合相關醫護資訊，共同討論醫療處置方向及措施，以恢復病人身心平衡。 This article described the nursing experience of caring a 73 years old patient with colorectal cancer combined with peritoneal pseudomyxoma, who felt hopelessness when facing the impact of two types of cancer. During the caring period from February 1 to 15, 2016, Gordon's 11 functional health patterns were used as guidance to collect the patient's medical history and information. The results revealed that the patient's health problems, including hopelessness, ineffective tissue perfusion/failure of gastrointestinal, and disturbed body image. Hopelessness was due to the physical and psychological problems from facing two cancers. The nursing process started with establishing a good nurse-patient relationship, followed by providing a safe and private caring environment, understanding the patient's feelings and needs, and encouraging the patient express his feelings. The medical team worked with the family to develop a care plan to help the patient identify his significance, accept the changes as the disease progressed, improve self-care ability, and maintain quality of life. Through sharing our experience, we can provide nursing staff with a reference for providing care to similar patientss.