運用腫瘤領航護理照顧一位門診罕見腫瘤復發病人心理調適之經驗

Experience Using Oncology Nurse Navigation to Help the Psychological Adjustment of an Outpatient With Rare Tumor Recurrence

「腫瘤領航護理」是藉由專業的服務，整合醫療照護繁瑣的程序，並以病人需求為中心，主動察覺病人主要護理問題，以事前評估及整合醫療照護訊息，讓癌症病人及家屬可從初次門診階段直到治療緩解追蹤期都能得到完整的醫療資訊與護理照護引導。本文描述一位旅居海外53歲已婚華人婦女，在臺診斷罕見疾病，決定留臺就醫，治療兩年期間經歷腫瘤復發，長時間處在復發所造成身心不適、疼痛、不明確治療結果與壓力等問題之下，誘發心理調適出現負向身心症狀；案夫因需支持家中經濟而無法時刻留在案主身邊掌握狀況，多次面臨妻子復發最後終於情緒崩潰。護理期間收集病人的主要需求問題，並使用情緒評估量表深入探究心理狀態，了解復發對她的影響，藉由門診個別化的居家指導照護、提供可用資源與訊息，引導他們發展因應技巧緩和身心症狀，再透過增強對疾病的認知能力，讓夫妻二人學習有益的因應措施，重新建立對身體與治療的自主權，一同面對疾病調適過程，重新適應現階段的生活。筆者期望藉由此腫瘤領航護理經驗，對未來醫護人員在面對門診不同階段的癌症病人能事前主動評估其需求，協助移除就醫阻礙，順利完成治療，達到癌症完整的治療與提高癌症治癒率。

Oncology Nurse Navigation is a professional service that integrates complex medical care procedures and promotes patient awareness of the major nursing problems. Using pre-assessment strategies and the integration of medical care information, Nurse Navigators help patients and their families gain comprehensive medical information and nursing care guidance from their initial post-diagnosis visit to their follow-up visits after remission. This article describes the author's experience with a 53-yearold married overseas Chinese woman who had been diagnosed with a rare tumor, PEComa, and who had traveled to Taiwan for treatment. During the outpatient care period with tumor progression, in addition to disease-related psychological and physical discomfort and pain, the prolonged uncertainty regarding treatment had induced adjustment difficulties and psychological symptoms in the patient. The patient's husband continued to work at his job in order to support the family's finances and was not able to maintain a close understanding of his wife's situation. He developed emotional stress when he saw his wife's disease relapse. The authors used Oncology Nurse Navigation approaches to actively assess the needs of the patient and her spouse, to explore their psychological state using emotional assessment scales, to understand the impact of recurrence on the family, to provide available resources and information, to help the couple learn to cope with psychological adjustment symptoms, to enhance their cognitive understanding of the disease, and to learn useful measures that helped them regain physical control, control over the treatment process, and effectively adapt to the disease and its effects. The authors' experience using Oncology Nurse Navigation with this patient may serve as a reference for healthcare professionals to facilitate the proactive assessment of patient needs at different stages of outpatient care, to remove barriers to seeking medical care through early interventions, and to implement a comprehensive and patient-centered approach to cancer treatment that may improve cancer treatment efficacy and quality of care.