運用個案管理模式照護一位接受根除性手術之攝護腺癌病人

Applying a Case Management Model to Care a Prostate Cancer Patient Receiving Radical Prostatectomy

本文運用個案管理照護模式協助一位於門診得知被診斷為攝護腺癌之個案面對疾病及治療之衝擊，並提供個案住院手術期間以及返家後的持續性照護。護理期間自2014年11月18日至2015年1月15日，於門診、住院治療、和非住院期間，運用羅式適應模式，並藉由觀察、訪視會談、身體評估、電話訪談等方式收集資料，以提供持續性、一致性及整體性照護。確立個案未手術前主要健康問題為焦慮;術後住院期間及返家後持續出現的問題為急迫性尿失禁和身體心像紊亂。筆者從個案得知診斷後即協助個案處理面對攝護腺癌的極度惶恐與求救無門的感覺，以及心中種種疑慮，即時提供相關資訊及運用同理心關懷個案，並安排治療前「病情說明會」與成功病友分享，同時依個案需求轉介諮商心理師，最後個案能在術前克服對罹病及治療之焦慮。對於術後住院及返家期間的面臨術後尿失禁副作用及身體心像之問題，除提供相關資訊及運用同理心關懷個案，並指導個案使用凱格爾會陰收縮運動及排尿日誌，最後個案能順利調適術後尿失禁及身體心像改變。期將此運用個案管理照護模式提供持續性諮詢窗口及完整的照護經驗，做為相關醫療人員照護癌症病人的參考。

The case management model is used to assist the patient who was diagnosed as prostate cancer in clinics to face the impacts of illness and treatment, and to provide continuous care during the journey. As soon as the patient was diagnosed, the case manager contacted with the patient, and assisted the patient during hospitalization as well as after discharge. From November 18th, 2014 to January 15th, 2015, the study applied the Roy's adaptation model, as well as observation, physical assessment, face to face interviews, and telephone interviews to collect information in order to provide continuous, consistent, and holistic care in the clinics during hospitalization and after discharge. The main health problem was the anxiety before the surgery, and there were urgent urinary incontinence and disturbed body image during postoperative hospitalization and after discharge. As soon as the patient was diagnosed in clinics, the case manager helped him deal with the extreme fear and helplessness for facing prostate cancer, as well as all the concerns for disease and treatments by immediately providing relevant information and caring the patient empathically. At the same time, the professional team had a meeting with the patient and families before surgery to reach a consensus for the disease and treatment. The case manager introduced another prostate patient to share his successful experience sharing with the patient before treatment, and this patient was referred to counselors according to patient's needs. Finally, he was able to overcome the anxiety for illness and treatment before surgery. After surgery, for the problems of incontinence and disturbed in body image during hospitalization and after discharge, the author also taught this patient how to do Kegel's exercise and how to write urinary diary in addition to providing information and caring. Finally, the patient could adapt smoothly for the problems after surgery. We suggest that health professional could apply the case management model to provide continuing consultation and integrity care when they care prostate cancer patients.