運用Watson關懷理論照顧一位腦瘤復發病人之護理經驗

Applying Watson's Theory in a Nursing Experience for a Patient with Brain Tumor Recurrence

本文探討一位43歲腦瘤復發女性，於2011年9月進行初次開顱手術，隔年二月腦瘤復發且併發癲癇住院，兩次住院筆者皆為主要負責護師，初次開刀時個案正向樂觀且主動詢問病情，此次開刀後右側肌力改變，讓個案由照顧者變成被照顧者，這樣的變化讓個案變得沈默、拒絕治療及要求家人立即辦理出院，無法與家屬達成共識，造成醫療團隊及家庭關係緊張。照護期間由2012年2月17日至3月10日，藉由會談與觀察等方式，以生理、心理、社會及靈性層面進行整體護理評估，確立主要健康問題：1)身體活動功能障礙、2)焦慮及3)家庭因應能力失調。運用Watson關懷理論中之關懷因子，透過醫護及復健師團隊，說明病情進展與提供個案及家屬腦瘤照護治療計劃，促進個案肢體功能最大化；營造及安排家庭成員聚會，分享心中想法，讓個案宣洩內心不安的情緒。措施介入後，個案能接受及配合治療，持續於門診服用口服化療藥物治療，且在個案及家屬同意下，於回診追蹤時訪談，以達到持續性之全程照護。期望藉此個案照護經驗分享，提供臨床照護之應用。

This case report describe the nursing experience of caring a 43-year-old female patient with brain tumor recurrence. The patient underwent her first craniotomy in September 2011 and suffered brain tumor recurrence with seizure in February 2012. As the primary care nurse during her two hospitalizations, I observed the patient became more pessimistic at the second time, because her muscle power was deteriorating, leading to the need for further care by others instead of by herself. Due to this abrupt change, she became silent, refused medical treatment, asked to be discharged immediately, and failed to reach an agreement with her family, thereby causing tension among herself, family members, and the medical team. The care period was from February 17 to March 10 in 2012. Watson’s caring theory was applied in the care plan. We explained the illness progression, provided brain tumor caring plan, maximized the patient’s physical function, arranged family meetings to share their opinions, and helped the patient express her feelings. After interventions, the patient accepted medical treatment and continued taking oral chemotherapy medicine from out-patient clinic. We had an interview under her agreement during her return to our service, so that she could receive thorough care. This case report provides some experiences for future clinical practice.