運用Watson理論及跨團隊模式照護一位思覺失調症合併十二指腸癌末期之病人

A Nursing Experience of Applying Watson Theory and Interdisciplinary Cooperation to a Schizophrenia patient with End-Stage Duodenal Cancer

本文主要為筆者運用Watson理論及跨團隊模式照護一位思覺失調症合併十二指腸癌末期病人之護理經驗。護理期間為2017年1月10日至2017年4月10日，藉由觀察、會談、身體評估及病歷回顧蒐集資料，以五大層面評估，發現其主要護理問題為慢性疼痛、營養不足、高危險性暴力行為：朝向他人。筆者藉由運用Watson理論，了解其拒絕治療之原因及其妄想內容之背後含意，取得病人信任後再協助提供其現實感及病識感，另外可藉由以病人為中心，從關懷的角度同理病人因身體疼痛及精神症狀相互影響而不想接受治療時，以鼓勵、傾聽及陪伴的方式，澄清其拒絕治療之原因，鼓勵病人以言語表達想法，減少使用暴力行為做為拒絕治療之方式。病人於住院期間，藉由使用藥卡合併圖片解釋的方式，接受止痛藥物的協助，疼痛指數由10分下降至3分；飲食部分透過與病人建立互信關係後，以跨團隊合作的方式，與病人討論飲食契約，以關懷及鼓勵的方式，了解病人需求並接受院內餐點及營養素補充，體重也可維持於59－60.5公斤間無持續下降情形；高危險性暴力部分，藉由護理師在執行任何治療前，與病人清楚解釋說明治療之目的，並教導其學習情緒管理之方法後，病人可連續兩週以上未再出現暴力行為。現今精神科合併內外科疾病之病人日益增加，希望藉由此份報告，能提供護理人員對思覺失調症合併十二指腸癌之相關照護知識，亦可做為臨床照護之參考。

This case study reported nursing experience of applying Watson Theory and Interdisciplinary Cooperation to a schizophrenia patient with end-stage duodenal cancer. The nursing care took place between 10th January and 27th April 2017. Five dimensions of psychiatric nursing evaluation were conducted using clinical observation, psychiatric interview, physical assessment and medical chart review. The main nursing diagnoses included Chronic pain, altered nutrition (less than body requirements), attempt to aggressive, altered thought processes and sensory/ perception alternation. The author review the reference and used Watson Theory to the patient, first to understand why patient refused the therapy, then after the relationship building and had trust to each other, provide sense of reality and to improve insight, accompanying patient calm and peace to the end stage. Applying Watson Theory enabled the patient (1) to accept used painkiller to reduce pain from score 10 to 3, (2) to keep the weight about 59 to 60.5kg and no loss, and (3) patient can tell about what does she think before any theropy, and finally reduced violance and agitation. Nowadays the patient with mental illness and physical disease are increasingly, and this report provided a better understanding of schizophrenia patient and end-stage duodenal cancer and might serve as a reference for nursing staff while taking care of patients with schizophrenia patient and endstage duodenal cancer in the future.