照顧一位直腸癌病人接受永久性腸造瘻口的護理經驗

Nursing Experience in Caring for a Rectal Cancer Patient with a Permanent Colostomy

本篇個案報告是描述照護ㄧ位直腸癌病人接受永久性腸造瘻口的護理經驗，護理期間2011年5月19日至6月6日。以Gordon十ㄧ項健康功能型態為評估工具，藉由觀察、傾聽、會談及身體評估等方式收集資料；發現個案主要的問題有焦慮、急性疼痛、特殊知識缺失、身體心像紊亂。針對個案的焦慮問題，於術前請醫師解說和澄清疑慮後獲減輕；有效運用疼痛護理緩解個案的傷口疼痛問題。運用造口圖片及模具區別個別性指導，教導個案學會操作腸造瘻口居家自我照護知識，藉由護理人員引導個案與病友的交流與互動，使個案接納身體心像的改變並能選擇合適的穿著。返家後的電訪追蹤，獲知個案不僅能自行獨立完成日常腸造瘻口清潔，且已開始恢復原有的社交生活。此次護理經驗，以病人為中心，考量其身、心、靈需求，並設計及運用合適的教具輔助，能增進病人照護技巧之學習成效，協助此類病人接受身體心像的改變及社交功能之復原，是全人照護成功的經驗分享。

This case report is a nursing experience in caring for a rectal cancer patient with a permanent colostomy. The duration of nursing care was from May 19 to June 6, 2011. The Gordon function health assessment guide was used to assess the nursing problems. Based on clinical data collected from observation, listening, conversation and physical examination, we found that the health problems were: anxiety, acute pain, special knowledge impairment and disturbance of body image. After preoperative physician's explanation, the anxiety caused by operation and postoperative care was reduced; the wound pain was also relieved by postoperative pain control and nursing intervention. In addition, we taught the case how to care for the colostomy at home and helped the case accept the change in physical appearance via clinical explanation, manipulation and sharing from other patients. Now, the case could not only independently clean and change the colostomy, but also began to participate in a friend's party as well as reentering the community. From this successful experience in holistic nursing, the use of the appropriate teaching models can increase learning effect, and help the case accept the change in body image.