以Swanson關懷理論照護一位初次同時診斷淋巴癌及糖尿病病人之護理經驗

Nursing Experience of Applying Swanson’s Caring Theory for a Patient Newly Diagnosed with Malignant Lymphoma and Diabetes Mellitus

本文運用Swanson關懷理論照護一位初次同時診斷淋巴癌及糖尿病病人克服疾病衝擊與身心不適的護理經驗，護理期間為2018年11月20日至28日，運用觀察、會談、身體評估及查閱病歷等方式，進行身、心、靈、社會的整體性評估，確立個案健康問題為噁心嘔吐、知識缺失及焦慮。以穴位按摩、服用含生薑成分之膠囊及漸進式肌肉放鬆等方式緩解噁心嘔吐；給予安靜的空間引導闡述內心感受及需求，並搭配喜愛的音樂及漸進式肌肉放鬆等方式緩解焦慮，輔以糖尿病自我管理及化療後骨髓抑制衛教，使病人學習疾病自我照護，並以正向積極的態度面對問題及克服疾病衝擊。糖尿病初次診斷病人之自我照護需求易被忽略，糖尿病衛教師介入臨床照護初次診斷糖尿病之病人，可使照護更周到與全面。

Patients with cancer face not only pain but also impacts on the body and spirit aspects due to the change of body appearance to experience negative feelings. This article described the nursing experience of caring a 63 years old male with stage III colorectal cancer. The patient presented with symptoms of abdominal pain and bloody stool passage for one year. He did not receive treatment until persuaded by his family members. Tumor invasion sites included ureter and bladder. He received intra-abdominal cancer excision, permanent colostomy, and cystostomy. The patient experienced negative feelings such as depression and hopelessness because he could not face the serious conditions of cancer and was worried about the unusual judgment of others after surgery. During the period of nursing care between September 15 and 27, 2017, the author used listening, communication, observation, interview, and Gordon 11 function health patterns analysis to identify the nursing problems. The results showed that the patient had anxiety problem before operation. The main nursing problems included acute pain, body image disturbance, and hopelessness. During the nursing process, both pharmacological pain controllers and essential oil massage were used to relieve pain. Good relationship between the patient and the nursing staff was built via accompanying and showing concerns and support for his family members. Moreover, care from interprofessional team was offered. The patient accepted his body appearance, adapted illness status, performed effective self-care for cystostomy, and finally turned negative attitude to positive. Interprofessional Practice (IPP) resource was offered to restore his self-confidence and successfully returned home to maintain good quality of life.