照護一位食道癌術後患者之護理經驗

Experience of Caring for a Post-Operative Patient with Esophageal Cancer

本文為照護一位食道癌患者行腫瘤切除術後之護理經驗。護理期間為2019年3月16日至2019 年4 月4日，筆者運用Gordon十一項健康功能型態為評估架構，藉由觀察、會談及身體評估等技巧完成資料收集，確立個案主要的護理問題有：急性疼痛／與術後傷口及管路留置有關；營養少於身體所需／與吞嚥困難、術後禁食有關；身體心像紊亂／與術後傷口及管路留置有關。筆者於照護期間以增進病患舒適為首要目標，積極改善其術後疼痛狀況，並協調醫療團隊照護改善個案的營養問題，及教導個案及案妻管灌及空腸造口換藥技巧，同時以傾聽、接納的態度了解個案內心感受，藉由正向食道癌病友分享心路歷程，使其逐漸接納術後身體心像的改變，期盼藉此護理經驗供臨床護理人員日後照護之參考。

This article described the experience of caring for a patient with esophageal cancer after tumor resection. The period of care was from March 16 to April 4, 2019. Using Gordon's eleven health function patterns as an assessment framework, the author completed data collection through observation, interview, and physical assessment techniques to establish that the main care issues were: acute pain associated with postoperative wound and catheterization; insufficient nutrition for the body caused by swallowing difficulties and postoperative fasting; body image disturbance due to postoperative wound and catheterization. With the primary goal of improving comfort during the care period, we actively improved the post-operative pain condition, and employed the medical team to take care of the nutritional problems of the case, and taught the patient and his wife the techniques of tube feeding and jejunostomy dressing change. At the same time, we learned about the inner feelings of the patient by listening tentatively in an accepting manner. Through learning the positive experiences from other esophageal cancer patients, the patient gradually accepted the changes in body image after surgery. It is hoped that this experience will serve as a reference for clinical nurses in their future care.