運用強化理論照顧一位大腸直腸癌造口留置病人之護理經驗

Nursing Experience of Applying the Reinforcement Theory to the Patient with Colorectal Cancer Combined with Ostomy

本文主要目的在分享運用強化理論於長期造口留置之大腸直腸癌病人，因造口適應困難所引發照護困擾的護理經驗。護理期間為2019年03月23日至2019年04月11日。筆者運用身體、心理、社會與靈性評估，經由實際觀察、會談、身體評估、直接照顧與門診追蹤等方式，確立個案護理問題為急性疼痛、現存性感染及知識缺失。針對急性疼痛，利用個案喜歡之活動與手機遊戲分散其注意力，合併止痛藥物的使用改善疼痛不適；感染性傷口方面，教導正確執行傷口自我照顧方法，以減少返家後傷口再次感染之問題；並根據史金納強化理論進行教育活動，提供專業知識，減輕知識缺失所帶來的困惑，以利於後續返家後照護。護理人員提供個案生理照顧及扮演支持者、諮詢者與傾訴者的角色，引導其訴說所害怕及擔心，協助個案面對問題、熟悉造口照護技能並增進自我控制，使個案返家後可以得到更好的生活與自我照護品質。

This article described the nursing experience of caring a colorectal cancer patient with long-term colostomy using reinforcement theory to promote self-care caused by adaptative difficulties. During the nursing period from March 23, 2019 to April 11, 2019, physical, psychological, social, and spiritual assessment were used to collect data through observation, interviews, physical assessment, direct care, and outpatient following. The identified health problems included acute pain, infections, and knowledge deficit. For acute pain, we provided the patient's favor activity, such as mobile game, combined with analgesic drug to relieve pain. We taught the patient the correct method to self-treat his infected wound to reduce the re-infection after discharge. We also provided professional knowledge to reduce the confusion according to Skinner's Reinforcement Theory in order to facilitate home care. In addition to providing physical care for the patient, the nursing staff also played the important role of supporters, counselors, and confidants. The nursing staff also guided the patient to tell about his fear and worry, helped him to face his problems, provided him with correct knowledge of colostomy, and improved self-control. These can help the patient to have a better life and self-care quality.