個案管理師角色於一位初診斷乳癌婦女術後行化學治療之照護經驗

The role of the case Manager in Post-Chemotherapy care of a Woman Newly Diagnosed with Breast Cancer

本文是運用個案管理師角色功能，引導一位48歲、未婚乳癌婦女能勇敢走出對人生無望，成功面對治療挑戰之照護經驗。照顧期間由2015年7月10日至12月12日，藉由與個案會談、觀察、傾聽及訪視等方式進行，並運用生理、心理、社會及靈性四大層面為評估指引，確立患者的護理問題，包括口腔黏膜改變、身體心像紊亂及無望感。筆者身為個案之腫瘤個案管理師，於初診斷的即時介入與其建立良好的治療性關係，並予個別性的衛教指導、提供乳癌照護相關資訊。在治療期間教導口腔清潔技巧，了解治療副作用的認知與建立正確觀念；當面對化療後掉髮產生身體心像改變的負向情緒及罹癌後對未來感到無望的心理負擔。適時給予正向鼓勵、關懷，主動安排相同經驗病友分享及適當資源轉介，引導個案接納外觀的改變，重燃對未來的希望並完成治療，適應疾病後的新生活。過程中仍透過持續性的電話追蹤，強化個案自我照顧的技巧，使其能接受積極的治療，獲得最佳身心的調適。 This paper describes the role of a case manager in guiding an unmarried 48-year-old woman with breast cancer to live courageously and successfully face the challenges of the treatment. Care was provided from July 10 to December 12, 2015, through case manager interviews, observations, listening, and visits, and by using assessment guidelines for physical, psychological, social, and spiritual functioning to frame the nursing-related problems of the patient, including oral mucosa changes, body dysmorphic disorder, and hopelessness. As a cancer case manager, I immediately intervened at the initial diagnosis, established a good therapeutic relationship with the patient, and provided individualized health education guidance and information on breast cancer care. During the treatment period, the patient was taught oral hygiene techniques, her understanding of the side effects of treatment were confirmed, and correct concepts were established. Hair loss after chemotherapy causes changes in body image and the psychological burden of hopelessness about the future. Positive encouragement and care were given at the appropriate time, and I took the initiative to facilitate interactions among patients with the same experience and provide appropriate resource referrals, guided the patients to accept the change in appearance, re-established hope for the future, the completion of the treatment, and adaptation to a new life after cancer. The process continued to enhance the patient's self-care skills through continuous tracking over the telephone so that she could proactively undergo treatment and achieve the best possible physical and mental adjustment.