運用品質關懷模式照顧一位因乳癌提早引產護理師之產後護理經驗

A Postpartum Nursing Experience of Applying Quality Caring Model to A Nurse Whose Early Induction of Labor was Due to Breast Cancer

乳癌是育齡婦女最常見癌症，懷孕期間被診斷乳癌，除將面臨癌症診斷及治療所帶來的身心衝擊，更將影響產後母性角色的發展。本文探討一位懷孕28週被診斷乳癌而提早引產護理師之產後護理經驗，照護期間自2020年12月18日至12月20日，筆者以觀察、會談、身體評估及病歷查閱等方式收集資料，並運用Gordon十一項功能性健康型態評估確立個案之健康問題有：急性疼痛、焦慮及親職功能障礙。照護過程運用Duffy品質關懷模式，藉「人類基本需求」、「共同解決問題」、「尊重」、「細心的再保證」及「鼓勵的方式」等品質關懷要素，提供產後照護指導、乳癌治療資訊及強化家庭支持系統等，緩解個案會陰傷口疼痛及因擔心產後乳癌治療、無法照顧案子所導致之焦慮；並引導擁抱、與新生兒肌膚接觸及參與新生兒照顧，建立個案母親的角色與自信心。期望此護理經驗能提供日後產後病房護理人員照顧同為護理人員之類似個案參考。

Breast cancer is the most prevalent cancer in women of reproductive age. Women diagnosed with breast cancer during pregnancy will face the physical and psychological impact of cancer diagnosis and treatment, and her development of maternal role will also be affected. The purpose of this article was to explore a postpartum nursing experience of a nurse whose early induction of labor was due to breast cancer. The nursing period was from Dec. 18 to 20, 2020. Gordon’s 11 functional health patterns assessment was used as a tool for the nursing assessment. The relevant data were collected through observations, interviews, physical assessments, and reviews of medical records. The major health problems identified included acute pain, anxiety, and impaired parenting. Applying Duffy’s Quality- Caring Model, quality care elements such as“basic human needs”,“mutual problem solving”,“human respect”,“attentive reassurance”, and“encouraging manner”were integrated into the caregiving process. By postpartum care, breast cancer medically related information, and strengthening the family support system, we relieved the patient’s pain of the perineal wound and anxiety caused by worries about postpartum breast cancer treatment and being unable to take care of her son. Through leading the patient to hug the baby, to have skin-to-skin contact and to participate in care, we established the patient’s mother role and self-confidence. Hopefully, this postpartum nursing experience can serve as a reference for health care professionals when caring for such patients.