運用品質關懷模式，照顧一位接受乳癌切除手術個案之門診護理經驗

An Outpatient Nursing Experience of Applying Quality Caring Model to a Patient Received Mastectomy

罹患乳癌不僅要面臨癌症死亡的威脅，更要面對乳房切除手術後身體不完整性的問題，對患者之身體及心理將造成極大的壓力。本文探討一位即將步入婚姻女性，面臨確診乳癌併接受乳房切除手術之門診護理經驗。護理期間自2019年12月13日至2020年1月18日，筆者以觀察、會談及身體評估等方式收集資料，並運用Gordon十一項功能性健康型態評估，確認個案主要之健康問題有：焦慮、急性疼痛及身體心像紊亂。門診照護過程運用Duffy品質關懷模式，藉「共同解決問題」、「尊重」、「歸屬感的需求」、「鼓勵的方式」及「人類基本需求」等品質關懷要素，透過主動評估並提供醫療相關資訊、教導傷口照顧及漸進式關節活動等，讓個案瞭解乳癌的預後及使用減輕疼痛的方法，緩解焦慮及疼痛；藉乳癌病友分享、鼓勵認同自我存在的價值及男友支持，使個案能檢視乳癌切除手術傷口，表達接受身體外觀改變的事實。期望此護理經驗能提供日後門診照顧類似個案參考。

Patients suffering from breast cancer face not only the threat of death but also physical incompleteness after mastectomy, which causes great physical and psychological stress on them. The purpose of this article was to explore an outpatient nursing experience of a patient received mastectomy. Nursing period was from December 13, 2019 to January 18, 2020. The data were collected through observation, interview, and physical assessment. Gordon's 11 functional health patterns assessment was used for nursing assessment. The major health problems identified included anxiety, acute pain, and body image disturbance. By using Duffy's quality caring model, quality care elements such as “mutual problem solving”, “human respect”, “affiliation needs”, “encouraging manner”, and “basic human needs” were used during the caregiving process. We provided active assessment, medically related information, wound care teaching, and progressive joint activities, etc., which let the patient understand the prognosis of breast cancer and pain relief methods to alleviate her anxiety and pain. Through the sharing by breast cancer supporting groups, encouragement to recognize the value of self-existence, and the support from her boyfriend, we enabled the patient to view the wound and express her acceptance of the body image changes after mastectomy. This nursing experience can serve as a reference for health care professionals when caring for outpatient breast cancer patient received mastectomy.