運用Leventhal自我調節理論於直腸癌病人術後身心困擾之護理經驗

Nursing Experience in the Application of Leventhal's Self-Regulation Theory to Postoperative Mental-Physical Disorders in Patients with Rectal Cancer

直腸癌病人術後常因身體結構及外觀改變，生理、心理、社會面臨重大的衝擊產生調適上的問題。本文敘述一位35歲診斷直腸癌男性，接受腫瘤切除手術併永久性腸造口，手術前醫師雖然已向病人解釋，但個案手術後仍無法接受永久性腸造口，進而產生拒絕學習及逃避的情緒反應，擔心出院後返回職場會影響工作狀況，害怕同事及顧客的異樣眼光。筆者於2018年4月18日至2018年5月4日照護期間，運用整體性評估，藉由觀察、傾聽、會談、身體評估及病歷查閱等方式進行資料收集，確立個案護理問題有：急性疼痛、身體心像紊亂、無效性因應能力。藉由Leventhal自我調節模式運用於生理及心理的照護，生理方面藉由評估發現病人有急性疼痛問題，指導病人轉移注意力的技巧，降低病人疼痛以促進舒適；心理方面，透過傾聽、陪伴與個案建立良好的治療性人際關係，提供醫療照護資訊使個案能調整心態，重新接受身體外觀改變的事實，進而主動參與自我照護，協助返回工作崗位並維持生活品質。期盼藉此照護經驗之分享，可供護理人員日後照顧此類病患之參考。

Patients with rectal cancer usually hard to cope with stress since they often experience big impact on physical, psychological, and social aspects due to changes to their body structures and appearances after surgery. This article described the nursing experience of taking care of a 35-year-old man with rectal cancer who received intra-abdominal cancer excision and permanent colostomy. Although the physician already explained to the patient, the patient still could not accept permanent changes resulting from colostomy and react with refusing to learn and disengaging. He was worried that his appearance would affect his working conditions and invite unpleasant judgment from his colleagues and clients. During the period of nursing care between April 18, 2018 and May 4, 2018, the author used integrity assessment to identify the nursing problems. Data were collected through observation, listening, interviews, physical assessment, and review of medical records. The following health issues were identified: acute pain, disturbance body image, and ineffective coping. Leventhal's self-regulation model was employed to physical and psychological care. Regarding the physical aspect, the patient was taught the skills of attentional shifting to relieve pain and promote comfort. Regarding the psychological aspect, listening and companion were applied to help establish good therapeutic relationship. Medical care information were provided so that the patient could adjust his attitude to accept his body appearance and adapted effective self-care. Consequently, the author helped the patient to return to work and maintain the quality of life. This nursing experience provided a useful reference for nursing.