運用關懷理論於一位年輕女性面對永久性迴腸造口之護理經驗

Nursing Experience of Applying a Care Theory to a Young Woman Undergoing Permanent Ileostomy

本文描述一位26歲女性，因罹患家族腺性瘜肉併發大腸癌，進行全大腸切除及迴腸造口術，導致身體外觀及排便功能型態改變，進而產生眼神淡漠、煩惱、情緒低落等情感反應。筆者於2017年10月4日至10月16日護理期間，藉由會談、溝通及Gordon十一項功能性健康評估，確主要健康問題「急性疼痛」、「身體心像紊」、「焦慮」，並以Watson關懷理論為基礎，運用人性化及利他主義價值系統以增進人際間教與學的互動，建立良好護病關係，提供個別性護理措施，護理過程中，生理方面除藥物治療外，非藥物治療使用芳香精油及束腹帶、播放個案喜愛的音樂，緩解術後腹部傷口的急性疼痛；心理方面透過家人和重要友人的正向鼓勵及YouTube勵志影片分享，運用跨團隊腸造口師教導腸造口居家照護技巧，協助個案重新適應於身體外觀的改變；將個案及其男友併入護理指導對象，安排共同參與迴腸造口病友團體的經驗分享以緩解個案的焦慮情緒，讓個案身、心及社會層面需求達到滿足。

This article described the nursing experience of caring a 26 years old female who received total excision of large intestine and permanent colostomy due to familial adenomatous polyposis. The patient faced a change of body image and functional reconstruction of defecation after surgery. She showed emotions such as a deplorable sight, upset, and negative mood. The author provided care-giving methods by following interview, communication, and Gordon 11 function health patterns analysis for collect data during the period of October 4, 2017 to October 16, 2017. The main nursing problems included acute pain, body image disturbance, and anxiety. The author adopted humanistic and altruism value system based on Watson's Caring Theory to enhance interpersonal relationship, to establish a positive nurse-patient relationship, and to offer an individualized nursing guidance. During the nursing process, in addition to medication, for the non-medical aspect, aromatherapy, abdominal belt, playing favorite music were applied to relieve acute pain of abdominal wound dehiscence after surgery. For the psychological aspect, the positive reinforcement of family members as well as friends, sharing YouTube motivational videos, and the instruction of home care of colostomy by the enterostomal therapist of the interdisciplinary team were applied to assist the patient readapting to the change of physical appearance. Both the patient and her boy friend were targets/objects of nursing guidelines, jointly participating and sharing experiences in a patient support group to relieve anxiety of the patient and to help her meet the physical, psychological, and social needs.