照護一位初次診斷食道癌病患之加護經驗

A Nursing Experience of Caring a Patient with Esophageal Cancer

本文為探討一位初次診斷食道癌個案，因呼吸困難插管入住加護病房之護理經驗。護理期間為2016年6月5日至6月15日止，運用羅氏適應模式的生理功能、自我概念、角色功能、相互依賴之概念架構，藉由直接照護、傾聽、觀察、會談、身體評估等方法收集資料，確認個案有疼痛、無望感及主要照護者之預期性哀傷等健康問題，在護理過程中，運用藥物及非藥物性輔助療法來緩解個案疼痛之生理問題，然而當個案初次診斷癌症，面對疾病惡化或死亡威脅時，表現出消極、冷漠、求生力喪失等負面情緒，此外，家屬面對個案初次罹癌時，亦出現預期性哀傷等心理問題，在這段發病的過程中，不論是個案或是家屬都承受極大的壓力，護理人員在面對初次罹患癌症個案情心情上的轉變，以及家屬心理方面的照護，運用陪伴、主動關懷及同理心等技巧，讓個案及家屬表達對罹癌的自我感受，使個案及家屬適應疾病過程，提升個案及家屬信心、希望感，共同分擔心理承受壓力、計劃治療方向及生活目標。將此護理經驗提出分享，期許能提供護理人員對相關個案照護之參考，以提升病患專業的照護品質。 This report described the nursing experience of utilizing Roy's Adaptation Model on a patient with an initial diagnosis of esophageal cancer. This patient was admitted into intensive care unit because of difficulty of breathing and intubation. The period of nursing caring was from June 5 to 15, 2016. Data were collected through observation, listening, interviews, and a physical assessment. During hospitalization, the patient experienced physical pain and negative emotion because of the deterioration of the disease and death threats and the patient's family members suffered from patient's unstable disease progression. Thus, pain, hopelessness, and primary care giver's anticipatory grief were confirmed as major nursing care problems. During the nursing care process, the authors used pharmacological and nonpharmacological therapy, such as aromatherapy to relieve patient's pain. At the same time, the author established a mutual trust nurse-patient therapeutic relationship, provided accompany, and gave appropriate information and emotional support to the patient and family, providing them with an understanding of the disease progress, possible complications, and recovery process to enhance the tolerance of disease adaptation, patient self-esteem, and family confidence. This experience provides useful information for other clinical nurses who care similar patients to enhance the quality of care.