運用Orem 理論於一位口腔癌患者行頭頸部重建之手術全期護理經驗

Application of Perioperative Nursing and Orem's Theory on a Patient with Oral Cancer Undergoing Head and Neck Reconstruction Surgery

本文旨探討一位口腔癌患者接受頭頸部重建術之手術全期護理經驗。於2012 年8 月12 日至30 日護理期間，運用Orem’s 自我照顧理論照護，透過訪談、觀察、身體評估、病歷查閱、訪視等方式收集資料，確立個案主要健康問題共四項：包含手術前期：一、口腔黏膜改變。二、焦慮。手術中期：一、潛在危險性皮膚完整性受損。手術後期：一、呼吸道清除功能失效。根據問題根本原因提供適切Orem 三大護理系統，主動提供手術全期正確相關訊息及個別需要護理活動，持續評值與照護使患者焦慮降低，坦然面對疾病改變並增強口腔黏膜的自我照顧能力，協助患者有效咳嗽以利呼吸道通暢，發現運用歐倫護理理論照護此個案，能有效重拾其信心並強化自我照護能力。建議促進頭頸部手術全期護理團隊之連續性照護，有利類似個案健康或自我照顧能力重建，作為類似個案照護之參考。

This article was to describe the perioperative nursing experience of an oral cancer patient undergoing head and neck reconstruction surgery. From August 12 to August 30, 2012, the author approached patients using Orem's theory of interview, observation, physical assessment, chart review and visit methods. Results from this nursing experience showed that the patient had four health problems. In the preoperative phase, the nursing problems include oral mucous membrane altered and anxiety. During operative phase, the nursing problem was mainly the potential risk of impairing skin integrity. In the postoperative nursing care phase, the major problem was ineffective airway clearance. The author provided adequate Orem’s nursing system to this patient with individualized guidance at different perioperative periods, including providing actively adequate information about the patient’s operation and health condition, individualized nursing interventions, continued evaluation to help the patient reduce anxiety, and holistic professional nursing care. By the practice of perioperative nursing, the anxiety of the patient was reduced, and his attitude improved. This practice had a positive impact on the disease. The patient adopted effective cough to improve airway clearance and obtain the self-care ability of oral mucous membrane. Orem self-care model can effectively improve the nursing care to this patient and his self-efficacy and self-care ability. The multiple reconstruction guideline for improving similar people's physical, ychological or self-care abilities were developed through the perioperative nursing and team work corporation approach. This study can be a reference for caring similar patients.