照護一位女性舌癌手術病人之護理經驗

Nursing Experience of Caring for a Female Patient with Tongue Cancer Surgery

本文主要探討一位初次診斷舌癌之62歲女性個案，術後面對身心靈改變衝擊之護理經驗。護理期間自2018年12月30日至2019年1月10日，筆者於住院期間經由觀察、會談、身體評估、傾聽等技巧收集資料，採用Gordon十一項功能性健康型態為評估工具，確認個案有焦慮、呼吸道清除功能失效、急性疼痛、身體心像改變等護理問題，提供個別性的護理計劃。鼓勵家屬一同參與照護計畫，並適時給予個案陪伴，建立良好的護病關係，進而降低其焦慮感，協助面對自我心情調適，以恢復自信心；提供胸腔物理治療，協助痰液排出以減少不適感；提供藥物及放鬆技巧來緩解疼痛；經醫療團隊協助，使個案能正視術後自我的改變，能面對疾病所帶來的壓力，重建個案對自我身體心像。建議未來醫療機構電訪追蹤系統，同步能結合視訊軟體，藉此觀察個案言談、情緒及家庭環境狀況，解決返家照護問題。希望藉此照護經驗，提供護理人員對照護口腔癌重建手術後個案之參考。

This article mainly discusses the case of a 62-year-old female who was initially diagnosed with tongue cancer, and the physiological and psychological impact after operation. The duration of care was from December 30, 2018 to January 10, 2019. Data was collected by observation, interview, physical assessment, and listening with Gordon's functional health pattern model. The patient's health problems were identified, including anxiety, ineffective airway clearance, acute pain, and body image disturbance. Individual and specific nursing care plans were then provided to assist the patient. Encouraging family members to participate in the care plan together and accompanying the patient are recommended in order to establish a sound nurse-patient relationship, and to reduce her anxiety level, improve her self-adjustment in mood, as well as to restore self-confidence. The patient received intensive chest physical therapy, coughing method to help get rid of the phlegm. The patient is also provided with medication and relaxation techniques to relieve pain. With the assistance of the medical team, the case is able to face the change in body and mind after the operation, deal with the resultant pressure from the disease, and rebuild the case's mental image of the self. It is recommended that in the future, the hospital telephone interview system can be synchronized with video software to observe the patient's speech, emotions, and family environment, and solve the care matters after returning home. It is expected that this nursing experience will improve a reference for nursing care of cases after oral cancer reconstruction surgery.