一位子宮頸根除術個案面對初次罹癌衝擊調適經驗

Nursing Experience with a Patient Adapting to Newly Diagnosed Cancer Post-Radical Hysterectomy

本文為照護一位32歲新婚半年，初次診斷子宮頸癌育齡婦女，接受手術治療後面對生理不適、疾病預後產生不確定感，及期望完成生育任務等多重壓力衝擊須調適之護理經驗。護理期間自2017年4月7日至2017年4月20日，筆者運用Gordon十一項健康功能型態進行護理評估，運用直接照護、觀察、會談、理學檢查與健康評估、查閱病歷等方式收集資料，確立其主要護理問題有：急性疼痛、焦慮、特定知識缺失、及排尿型態改變。護理期間筆者先與個案建立良好信任關係，運用個別性護理措施、醫療處置緩解生理問題，再以同理關懷、支持陪伴、正向鼓勵，適時關心需求，運用多元護理指導策略如人體模型、圖片與影片。除改善生理問題外，亦減輕對手術與日後治療之焦慮不安。促進所關注性生活和日後生育期待之重建與統整、提升化學治療期間之居家自我照顧知識。最終順利調適衝擊，並以正面積極態度面對疾病與未來治療，順利移除尿管與完成化學治療療程。期透過此照護經驗，做為護理人員日後照護婦女癌症參考依據。

TThe present study describes the nursing experience with a 32-year-old female patient, married for 6 months, with newly diagnosed cervical cancer who had to adapt to various stressors after surgical treatment, including physical discomfort, feelings of uncertainty regarding disease prognosis, and the desire to bear children. Nursing care was provided to the patient from April 7 to April 20, 2017. By performing a nursing assessment of the patient using Gordon's 11 Functional Health Patterns and data collection through direct care, observations, interviews, physical examination, health assessment, and medical record perusal, the main nursing problems were identified as follows: acute pain, anxiety, specific knowledge deficit, and changes in urination pattern. During the nursing period, a good rapport was established with the patient. Subsequently, the patient's physical discomfort was alleviated through individualized nursing measures and medical interventions. This was followed by the provision of empathy, care, support, companionship, positive encouragement, and appropriate attention to her needs. Multiple nursing guidance strategies, involving the humanbody model, images, and videos, were employed during the nursing process. In addition to alleviating her physical health problems, the patient's anxiety and unease towards surgery and subsequent treatment was also relieved. The nursing care administered to the patient also promoted the re-establishment and consolidation of the patient's expectations towards her sexual health and childbearing. Eventually, the patient adapted smoothly to the shock of newly diagnosed cancer, adopted a positive attitude towards the disease and future treatment, underwent a successful Foley catheter removal, and completed chemotherapy treatment. This nursing experience may serve as a reference for future nurses involved in providing care to female patients with cancer.