照顧一位直腸癌個案接受永久性腸造瘻口之護理經驗

The Nursing Experience for a Colorectal Cancer Patient with a Permanent Colostomy

本文描述一位直腸癌個案接受永久性腸造瘻口術後之照護經驗，護理期間為2014 年3 月5 日至3 月24 日，筆者運用Gordon 十一項功能性健康型態為評估工具，藉由觀察、會談及身體評估等技巧，收集個案之相關資料分析後，確認個案健康問題包括：急性疼痛、身體心像紊亂及知識缺失。在護理過程中，協助個案與家屬接受腸造瘻口，學會腸造口相關的自我照護，並扮演傾聽、支持及諮詢的角色，引導其訴說擔心與害怕，重新調適身體心像改變的衝擊，進而讓個案願意學習腸造瘻口自我照護相關知識與自我照顧技巧。此次護理經驗以病人為中心，除了考量其身、心、靈需求，並透過病友提供關懷與分享，引導個案主動述說感受及增進家庭成員的照護技巧，能協助類似個案面對身體心像的改變及造瘻口衝擊，重建自信回歸家庭，擁有正常生活之經驗分享。

This article described the nursing care provided to a colorectal cancer patient following permanent colostomy surgery. The care period was between March 5 and 24, 2014. The Gordon function health assessment guide was used to assess the nursing problems. The author employed several approaches of observation, conversation, and physical examination to collect and analyze the clinical data of the patient. Consequently, the author attributed the patient’s health problems to acute pain, body image disturbance, and lack of knowledge. During the nursing process, the author assisted the patient and the patient’s family members in understanding colostomy and educated them relevant self-care techniques. In addition, the author assumed the roles of a listener, supporter, and advisor to encourage the patient to express her worries and fears and to assist her in adjusting to the changes in body image, thereby increasing her willingness to learn relevant self-care knowledge and techniques. The patient-centered nursing approach adopted by the author accounted for the physical, mental, and spiritual demands of the patient, actively relieved concerns of the patient, increased the patient’s willingness to express her feelings, and improved the care skills of the patient’s family members. The author concluded that the proposed nursing approach is beneficial for helping similar patients accept their body image, reestablish confidence, and return to their families and everyday lives as well as for reducing the impact of stoma surgery.